Provider Demographics
NPI:1669517595
Name:ROBERTA DRUG CO INC
Entity type:Organization
Organization Name:ROBERTA DRUG CO INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:L
Authorized Official - Last Name:BELL
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:478-836-3515
Mailing Address - Street 1:PO BOX 418
Mailing Address - Street 2:
Mailing Address - City:ROBERTA
Mailing Address - State:GA
Mailing Address - Zip Code:31078-0418
Mailing Address - Country:US
Mailing Address - Phone:478-836-3515
Mailing Address - Fax:478-836-3319
Practice Address - Street 1:4 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:ROBERTA
Practice Address - State:GA
Practice Address - Zip Code:31078
Practice Address - Country:US
Practice Address - Phone:478-836-3515
Practice Address - Fax:478-836-3319
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2008-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0032123336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA00035142AMedicaid