Healthcare Provider Details

I. General information

NPI: 1619998663
Provider Name (Legal Business Name): ROBERDS SPECIALTY PHARMACY LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/22/2006
Last Update Date: 11/27/2020
Certification Date: 11/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2510 S LOOP 336 W STE 105
CONROE TX
77304-3737
US

IV. Provider business mailing address

503 MEDICAL CENTER BLVD STE 130
CONROE TX
77304-2928
US

V. Phone/Fax

Practice location:
  • Phone: 936-756-4254
  • Fax: 936-756-6252
Mailing address:
  • Phone: 936-756-4254
  • Fax: 936-756-6252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number30619
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: VAN TRAN
Title or Position: OWNER
Credential:
Phone: 936-756-4254