Provider Demographics
NPI:1104900372
Name:ROBERTS, VIRGINIA MACLEAN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:VIRGINIA
Middle Name:MACLEAN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 BANK ST
Mailing Address - Street 2:#187
Mailing Address - City:GRASS VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:95945-6518
Mailing Address - Country:US
Mailing Address - Phone:530-272-3223
Mailing Address - Fax:
Practice Address - Street 1:111 BANK ST
Practice Address - Street 2:#187
Practice Address - City:GRASS VALLEY
Practice Address - State:CA
Practice Address - Zip Code:95945-6518
Practice Address - Country:US
Practice Address - Phone:530-272-3223
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-25
Last Update Date:2012-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 35015183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist