Healthcare Provider Details

I. General information

NPI: 1255413035
Provider Name (Legal Business Name): ROBERTSON DRUG CO INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2006
Last Update Date: 04/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6109 FORT AVE
LYNCHBURG VA
24502-1933
US

IV. Provider business mailing address

6109 FORT AVE
LYNCHBURG VA
24502-1933
US

V. Phone/Fax

Practice location:
  • Phone: 434-239-2621
  • Fax: 434-239-3050
Mailing address:
  • Phone: 434-239-2621
  • Fax: 434-239-3050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number0201000723
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL ROBERTSON
Title or Position: PRES
Credential: RPH
Phone: 434-239-2621