Provider Demographics
NPI:1790109965
Name:ROBERTSON, ROBERT (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:235 ROBT DANEL JR PKWY
Mailing Address - Street 2:STORE #1090
Mailing Address - City:AUGUSTA
Mailing Address - State:GA
Mailing Address - Zip Code:30909-0800
Mailing Address - Country:US
Mailing Address - Phone:706-733-3011
Mailing Address - Fax:
Practice Address - Street 1:235 ROBT DANEL JR PKWY
Practice Address - Street 2:STORE #1090
Practice Address - City:AUGUSTA
Practice Address - State:GA
Practice Address - Zip Code:30909-0800
Practice Address - Country:US
Practice Address - Phone:706-733-3011
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-02-09
Last Update Date:2014-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027639183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist