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NPI Code Detail

MEDICARE: DR. ANDRE ROBERTS PHARMD

MEDICARE: DR. ANDRE ROBERTS PHARMD
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist051302759IL

General Provider Information

NPI Number : 1194361196
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. ANDRE ROBERTS PHARMD
Provider Business Mailing Address
First Line : 18051 TARPON CT
Second Line :
City : HOMEWOOD
State : IL
Zip : 60430-1430
Country : US
Telephone Number : 312-501-4659
Fax Number :
Provider Business Practice Location Address
First Line : 4748 W NORTH AVE
Second Line :
City : CHICAGO
State : IL
Zip : 60639-4640
Country : US
Telephone Number : 773-745-6642
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/25/2019
Last Update Date : 11/25/2019

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Directions to “ DR. ANDRE ROBERTS PHARMD” Practice Location

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