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NPI Code Detail

MEDICARE: NATHAN ROBERSON

MEDICARE:   NATHAN  ROBERSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist17159AL

General Provider Information

NPI Number : 1144576323
Entity Type Code : Individual
Provider Name (Legal Business Name) : NATHAN ROBERSON
Provider Business Mailing Address
First Line : 1207 MEDICAL DR SE
Second Line :
City : DECATUR
State : AL
Zip : 35601-4330
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 1207 MEDICAL DR SE
Second Line :
City : DECATUR
State : AL
Zip : 35601-4330
Country : US
Telephone Number : 256-353-5011
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/25/2012
Last Update Date : 07/25/2012

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Directions to “ NATHAN ROBERSON ” Practice Location

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