Healthcare Provider Details

I. General information

NPI: 1326141375
Provider Name (Legal Business Name): ROBERTS PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/06/2006
Last Update Date: 04/13/2020
Certification Date: 04/13/2020
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 157
DONALSONVILLE GA
39845-0157
US

V. Phone/Fax

Practice location:
  • Phone: 229-524-2313
  • Fax: 229-524-1202
Mailing address:
  • Phone: 229-524-2313
  • Fax: 229-524-1202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberPHRE004506
License Number StateGA

VIII. Authorized Official

Name: RHONDA RATHEL
Title or Position: STORE MANG/OWNER
Credential:
Phone: 229-524-2313