Healthcare Provider Details

I. General information

NPI: 1578613675
Provider Name (Legal Business Name): ROBERTS PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/11/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

218 N CONGRESS ST
RUSHVILLE IL
62681-1402
US

IV. Provider business mailing address

218 N CONGRESS ST
RUSHVILLE IL
62681-1402
US

V. Phone/Fax

Practice location:
  • Phone: 217-322-3383
  • Fax: 217-322-6033
Mailing address:
  • Phone: 217-322-3383
  • Fax: 217-322-6033

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number004984
License Number StateIL

VIII. Authorized Official

Name: LARRY ROBERTS
Title or Position: PHARMACIST
Credential:
Phone: 217-322-3383