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 1:863 BALTIMORE PIKE
Mailing Address - Street 2:
Mailing Address - City:GLEN MILLS
Mailing Address - State:PA
Mailing Address - Zip Code:19342-1057
Mailing Address - Country:US
Mailing Address - Phone:103-612-8226
Mailing Address - Fax:
Practice Address - Street 1:863 BALTIMORE PIKE
Practice Address - Street 2:
Practice Address - City:GLEN MILLS
Practice Address - State:PA
Practice Address - Zip Code:19342-1057
Practice Address - Country:US
Practice Address - Phone:103-612-8226
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2025-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP459305183500000X
DEA1-0004588183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist