Provider Demographics
NPI:1770693780
Name:COX, ROBERTA JEAN (RPH)
Entity type:Individual
Prefix:MS
First Name:ROBERTA
Middle Name:JEAN
Last Name:COX
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MS
Other - First Name:ROBERTA
Other - Middle Name:JEAN
Other - Last Name:LENTZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12684 W CRYSTALVUE LANE
Mailing Address - Street 2:
Mailing Address - City:CRYSTAL RIVER
Mailing Address - State:FL
Mailing Address - Zip Code:34428
Mailing Address - Country:US
Mailing Address - Phone:352-447-2972
Mailing Address - Fax:
Practice Address - Street 1:3711 E SILVER SPRINGS BLVD
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4903
Practice Address - Country:US
Practice Address - Phone:352-694-4111
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2010-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0039742183500000X
OH03-2-26145183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL102097800Medicaid