Healthcare Provider Details

I. General information

NPI: 1841419231
Provider Name (Legal Business Name): NATHANIEL JOLO ROBERTS PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 03/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WALTER REED NATIONAL MILITARY CTR 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

IV. Provider business mailing address

WALTER REED NATIONAL MILITARY CTR 8901 WISCONSIN AVE
BETHESDA MD
20889-0001
US

V. Phone/Fax

Practice location:
  • Phone: 301-400-2735
  • Fax:
Mailing address:
  • Phone: 301-400-2735
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number2002009911
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: