Provider Demographics
NPI:1356943534
Name:ROBESON, DAVID
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:
Last Name:ROBESON
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 SHALLOWFORD RD NW
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30504-4152
Mailing Address - Country:US
Mailing Address - Phone:770-531-0325
Mailing Address - Fax:770-531-0338
Practice Address - Street 1:400 SHALLOWFORD RD NW
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:GA
Practice Address - Zip Code:30504-4152
Practice Address - Country:US
Practice Address - Phone:770-531-0325
Practice Address - Fax:770-531-0338
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-12
Last Update Date:2020-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH023894183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist