Provider Demographics
NPI:1336356526
Name:ROBERTS PHARMACY
Entity Type:Organization
Organization Name:ROBERTS PHARMACY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:LEONARD
Authorized Official - Middle Name:J
Authorized Official - Last Name:MOSKOWITZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-642-4788
Mailing Address - Street 1:2377 HAVERFORD ROAD
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:PA
Mailing Address - Zip Code:19003
Mailing Address - Country:US
Mailing Address - Phone:610-642-4788
Mailing Address - Fax:610-642-6807
Practice Address - Street 1:2377 HAVERFORD ROAD
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:PA
Practice Address - Zip Code:19003
Practice Address - Country:US
Practice Address - Phone:610-642-4788
Practice Address - Fax:610-642-6807
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP0187132183500000X
PAPP412104L333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered183500000XPharmacy Service ProvidersPharmacistGroup - Multi-Specialty
Not Answered333600000XSuppliersPharmacy