Healthcare Provider Details

I. General information

NPI: 1801871090
Provider Name (Legal Business Name): MICHAEL HENRY ROBERGE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/09/2005
Last Update Date: 07/19/2022
Certification Date: 07/19/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

179 MAIN ST COMPOUNDED SOLUTIONS IN PHARMACY
MONROE CT
06468-1107
US

IV. Provider business mailing address

179 MAIN ST COMPOUNDED SOLUTIONS IN PHARMACY
MONROE CT
06468-1107
US

V. Phone/Fax

Practice location:
  • Phone: 203-268-4964
  • Fax: 203-268-5492
Mailing address:
  • Phone: 203-268-4964
  • Fax: 203-268-5492

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number7409
License Number StateCT

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: