Provider Demographics
NPI:1285060574
Name:ROBERTS, DENNIS EDWARD (DPH)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:EDWARD
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:694 SPAINWOOD CV
Mailing Address - Street 2:
Mailing Address - City:MEMPHIS
Mailing Address - State:TN
Mailing Address - Zip Code:38120-2835
Mailing Address - Country:US
Mailing Address - Phone:901-226-5249
Mailing Address - Fax:901-226-5792
Practice Address - Street 1:6019 WALNUT GROVE RD
Practice Address - Street 2:PHARMACY ADMINISTRATION
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38120-2113
Practice Address - Country:US
Practice Address - Phone:901-226-5249
Practice Address - Fax:901-226-5792
Is Sole Proprietor?:No
Enumeration Date:2013-09-19
Last Update Date:2013-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist