Provider Demographics
NPI:1184134884
Name:ROBERTS, DEBORAH (RPH)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:96 HERON HILL RD
Mailing Address - Street 2:
Mailing Address - City:AMSTON
Mailing Address - State:CT
Mailing Address - Zip Code:06231-1654
Mailing Address - Country:US
Mailing Address - Phone:860-966-1918
Mailing Address - Fax:
Practice Address - Street 1:141B STORRS RD
Practice Address - Street 2:
Practice Address - City:MANSFIELD CENTER
Practice Address - State:CT
Practice Address - Zip Code:06250-1638
Practice Address - Country:US
Practice Address - Phone:860-456-1358
Practice Address - Fax:860-456-1384
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-07
Last Update Date:2017-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7265183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist