Provider Demographics
NPI:1740695311
Name:ROBERTS, BRUCE A (PHARMD)
Entity type:Individual
Prefix:DR
First Name:BRUCE
Middle Name:A
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4609 KIRKWOOD HWY
Mailing Address - Street 2:
Mailing Address - City:WILMINGTON
Mailing Address - State:DE
Mailing Address - Zip Code:19808-5005
Mailing Address - Country:US
Mailing Address - Phone:302-994-2591
Mailing Address - Fax:302-994-0758
Practice Address - Street 1:4609 KIRKWOOD HWY
Practice Address - Street 2:
Practice Address - City:WILMINGTON
Practice Address - State:DE
Practice Address - Zip Code:19808-5005
Practice Address - Country:US
Practice Address - Phone:302-994-2591
Practice Address - Fax:302-994-0758
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DEA1-0004588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist