Provider Demographics
NPI:1922335009
Name:ROBERTS, GREGORY LEE (RPH)
Entity Type:Individual
Prefix:
First Name:GREGORY
Middle Name:LEE
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4800B HIGHWAY 365
Mailing Address - Street 2:
Mailing Address - City:PORT ARTHUR
Mailing Address - State:TX
Mailing Address - Zip Code:77642-7403
Mailing Address - Country:US
Mailing Address - Phone:409-722-4066
Mailing Address - Fax:409-722-4588
Practice Address - Street 1:4800B HIGHWAY 365
Practice Address - Street 2:
Practice Address - City:PORT ARTHUR
Practice Address - State:TX
Practice Address - Zip Code:77642-7403
Practice Address - Country:US
Practice Address - Phone:409-722-4066
Practice Address - Fax:409-722-4588
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2010-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22219183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist