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General NPI Number Information
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NPI Number | 1023617453
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Entity Type | Individual
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Provider Name | JORGE ROBLEDO
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Gender | Male
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Dates
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Enumeration Date | 10/16/2020
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Last Update Date | 10/16/2020
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Provider Practice Location Address
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Address Line | 2955 ATLANTA RD SE
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City | SMYRNA
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State | GA
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Zip | 30080-3651
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Country | US
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Telephone | 770-319-1123
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Fax |
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Provider Business Mailing Address
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Address Line | 221 PARC DR
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City | CANTON
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State | GA
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Zip | 30114-9785
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Country | US
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Telephone | 617-824-0003
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | RPH023977
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License Number State | GA
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