Provider Demographics
NPI:1932610961
Name:ROBERTS, REBEKAH (PHARM D)
Entity Type:Individual
Prefix:
First Name:REBEKAH
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:990 LEON BADEN RD
Mailing Address - Street 2:
Mailing Address - City:LEON
Mailing Address - State:WV
Mailing Address - Zip Code:25123-8700
Mailing Address - Country:US
Mailing Address - Phone:304-674-5982
Mailing Address - Fax:
Practice Address - Street 1:2501 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:POINT PLEASANT
Practice Address - State:WV
Practice Address - Zip Code:25550-2035
Practice Address - Country:US
Practice Address - Phone:304-675-2303
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-17
Last Update Date:2017-10-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRPH.03237271-2183500000X
WVRP0010217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist