Provider Demographics
NPI:1245706019
Name:GARCIA, ROBERTO CLEMENTE (PHARMD)
Entity type:Individual
Prefix:
First Name:ROBERTO
Middle Name:CLEMENTE
Last Name:GARCIA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6741 W GIBSON AVE
Mailing Address - Street 2:
Mailing Address - City:FRESNO
Mailing Address - State:CA
Mailing Address - Zip Code:93723-4019
Mailing Address - Country:US
Mailing Address - Phone:559-392-7288
Mailing Address - Fax:
Practice Address - Street 1:1300 W YOSEMITE AVE
Practice Address - Street 2:
Practice Address - City:MADERA
Practice Address - State:CA
Practice Address - Zip Code:93637-6320
Practice Address - Country:US
Practice Address - Phone:559-673-8172
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-19
Last Update Date:2018-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA79637183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist