Provider Demographics
NPI:1871290452
Name:ROBERTS, AMANDA VICTORIA (PHARMD, RPH)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:VICTORIA
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 CONCORD CT
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30214-1808
Mailing Address - Country:US
Mailing Address - Phone:404-538-3138
Mailing Address - Fax:
Practice Address - Street 1:130 CONCORD CT
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214-1808
Practice Address - Country:US
Practice Address - Phone:404-538-3138
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-14
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH034139183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist