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General NPI Number Information
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NPI Number | 1619998663
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Entity Type | Organization
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Legal Business Name | ROBERDS SPECIALTY PHARMACY LLC
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Dates
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Enumeration Date | 07/22/2006
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Last Update Date | 11/27/2020
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Provider Practice Location Address
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Address Line | 2510 S LOOP 336 W STE 105
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City | CONROE
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State | TX
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Zip | 77304-3737
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Country | US
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Telephone | 936-756-4254
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Fax | 936-756-6252
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Provider Business Mailing Address
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Address Line | 503 MEDICAL CENTER BLVD STE 130
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City | CONROE
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State | TX
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Zip | 77304-2928
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Country | US
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Telephone | 936-756-4254
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Fax | 936-756-6252
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Authorized Official
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Title or Position | OWNER
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Name | VAN TRAN
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Credential |
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Telephone | 936-756-4254
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0004X
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Taxonomy Name | Compounding Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 30619
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License Number State | TX
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