Provider Demographics
NPI:1649022534
Name:PATE, ROBERT (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:
Last Name:PATE
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 1:288 EVERGREEN RD
Mailing Address - Street 2:
Mailing Address - City:SHELBY
Mailing Address - State:AL
Mailing Address - Zip Code:35143-5117
Mailing Address - Country:US
Mailing Address - Phone:205-267-7244
Mailing Address - Fax:
Practice Address - Street 1:689 BROOKE MANOR CT
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30045-3160
Practice Address - Country:US
Practice Address - Phone:205-267-7244
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-03
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034780183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist