=====================================================
General NPI Number Information
=====================================================
NPI Number | 1356777569
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROBESON HEALTH CARE CORPORATION
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/19/2013
-----------------------------------------------------
Last Update Date | 11/08/2019
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 610 E DR MARTIN LUTHER KING JR DR
-----------------------------------------------------
City | MAXTON
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28364
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-844-5253
-----------------------------------------------------
Fax | 910-844-3290
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 60 COMMERCE PLAZA CIR
-----------------------------------------------------
City | PEMBROKE
-----------------------------------------------------
State | NC
-----------------------------------------------------
Zip | 28372-7386
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 910-521-2900
-----------------------------------------------------
Fax | 910-775-9165
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT/CEO
-----------------------------------------------------
Name | GEORGE TIMOTHY HALL
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 910-521-2900
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------