MEDICARE: ROBERT SUNDER ROBERTS B.S.PHARMACY

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
1	183500000X	Pharmacist	046100	NY
2	183500000X	Pharmacist	RP447633	PA
3	183500000X	Pharmacist	28RI03573000	NJ

General Provider Information

NPI Number	:	1366610289
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROBERT SUNDER ROBERTS B.S.PHARMACY

Provider Business Mailing Address
First Line	:	227 9TH AVE
Second Line	:	GRISTEDES PHARMACY 545
City	:	NEW YORK
State	:	NY
Zip	:	10011-4934
Country	:	US
Telephone Number	:	212-807-0950
Fax Number	:	212-243-1568

Provider Business Practice Location Address
First Line	:	227 9TH AVE
Second Line	:	GRISTEDES PHARMACY 545
City	:	NEW YORK
State	:	NY
Zip	:	10011-4934
Country	:	US
Telephone Number	:	212-807-0950
Fax Number	:	212-243-1568

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/13/2008
Last Update Date	:	02/25/2021

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