MEDICARE: TIMOTHY R ROBERTSON RPH

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	0202010109	VA

General Provider Information

NPI Number	:	1891399945
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TIMOTHY R ROBERTSON RPH

Provider Business Mailing Address
First Line	:	15 DILLARD LN
Second Line	:
City	:	ROCKY MOUNT
State	:	VA
Zip	:	24151-2401
Country	:	US
Telephone Number	:	540-580-5289
Fax Number	:

Provider Business Practice Location Address
First Line	:	400 RIVERSIDE DR
Second Line	:
City	:	BASSETT
State	:	VA
Zip	:	24055-4394
Country	:	US
Telephone Number	:	276-629-2547
Fax Number	:

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

Provider Enumeration Date	:	11/29/2020
Last Update Date	:	11/29/2020

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