Provider Demographics
NPI:1053578989
Name:ROBERTS, GEORGE ALBERT JR (RPH)
Entity type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:ALBERT
Last Name:ROBERTS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:207 EAST MAIN STREET
Mailing Address - Street 2:
Mailing Address - City:REMINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22734
Mailing Address - Country:US
Mailing Address - Phone:540-439-3247
Mailing Address - Fax:540-439-9822
Practice Address - Street 1:207 EAST MAIN STREET
Practice Address - Street 2:
Practice Address - City:REMINGTON
Practice Address - State:VA
Practice Address - Zip Code:22734
Practice Address - Country:US
Practice Address - Phone:540-439-3247
Practice Address - Fax:540-439-9822
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-19
Last Update Date:2008-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202005279183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist