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General NPI Number Information
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NPI Number | 1063557791
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Entity Type | Individual
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Provider Name | CULLIE TAYLOR ROBERTS JR. R.PH.
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Gender | Male
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Dates
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Enumeration Date | 02/20/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 301 HOSPITAL DR
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City | CLEVELAND
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State | MS
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Zip | 38732-2358
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Country | US
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Telephone | 662-843-3654
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Fax | 662-843-3622
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Provider Business Mailing Address
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Address Line | 1005 ROSEMARY RD
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City | CLEVELAND
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State | MS
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Zip | 38732-2073
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Country | US
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Telephone | 662-843-3416
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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 | E7319
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License Number State | MS
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