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NPI Code Detail

MEDICARE: ROBERDS SPECIALTY PHARMACY LLC

MEDICARE: ROBERDS SPECIALTY PHARMACY LLC
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
13336C0004XCompounding Pharmacy
23336C0003XCommunity/Retail Pharmacy30619TX

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
22156162OTHERPK

General Provider Information

NPI Number : 1619998663
Entity Type Code : Organization
Provider Name (Legal Business Name) : ROBERDS SPECIALTY PHARMACY LLC
Provider Business Mailing Address
First Line : 503 MEDICAL CENTER BLVD STE 130
Second Line :
City : CONROE
State : TX
Zip : 77304-2928
Country : US
Telephone Number : 936-756-4254
Fax Number : 936-756-6252
Provider Business Practice Location Address
First Line : 2510 S LOOP 336 W STE 105
Second Line :
City : CONROE
State : TX
Zip : 77304-3737
Country : US
Telephone Number : 936-756-4254
Fax Number : 936-756-6252
Authorized Official
Title or Position : OWNER
Name : VAN TRAN
Credential :
Telephone Number : 936-756-4254
Provider Enumeration Date : 07/22/2006
Last Update Date : 11/27/2020

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Directions to “ROBERDS SPECIALTY PHARMACY LLC ” Practice Location

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