Provider Demographics
NPI:1154528701
Name:ROBERTSON, MICHAEL R (RPH)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:R
Last Name:ROBERTSON
Suffix:
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 1:509 WINDING WAY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:SC
Mailing Address - Zip Code:29212-1354
Mailing Address - Country:US
Mailing Address - Phone:803-781-5296
Mailing Address - Fax:
Practice Address - Street 1:7467 SAINT ANDREWS RD STE 6
Practice Address - Street 2:
Practice Address - City:IRMO
Practice Address - State:SC
Practice Address - Zip Code:29063-2876
Practice Address - Country:US
Practice Address - Phone:803-732-0426
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC4979183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist