Healthcare Provider Details

I. General information

NPI: 1710902531
Provider Name (Legal Business Name): ROBERTS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/13/2006
Last Update Date: 12/23/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

803 N WILEY AVE
DONALSONVILLE GA
39845-1121
US

IV. Provider business mailing address

PO BOX 5047
MERIDIAN MS
39302-5047
US

V. Phone/Fax

Practice location:
  • Phone: 229-524-2313
  • Fax: 229-524-1202
Mailing address:
  • Phone: 800-447-4095
  • Fax: 601-482-7490

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code332BP3500X
TaxonomyParenteral & Enteral Nutrition Supplies (DME)
License NumberPHRE004506
License Number StateGA
# 2
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License NumberPHRE004506
License Number StateGA
# 3
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE004506
License Number StateGA
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License NumberPHRE004506
License Number StateGA
# 5
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License NumberPHRE004506
License Number StateGA
# 6
Primary TaxonomyN
Taxonomy Code3336M0002X
TaxonomyMail Order Pharmacy
License NumberPHRE004506
License Number StateGA
# 7
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License NumberPHRE004506
License Number StateGA
# 8
Primary TaxonomyY
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License NumberPHRE004506
License Number StateGA

VIII. Authorized Official

Name: JACK H MILLS
Title or Position: PRESIDENT
Credential:
Phone: 229-524-2313