Provider Demographics
NPI:1366610289
Name:ROBERTS, ROBERT SUNDER (BSPHARMACY)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:SUNDER
Last Name:ROBERTS
Suffix:
Gender:M
Credentials:BSPHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:227 9TH AVE
Mailing Address - Street 2:GRISTEDES PHARMACY 545
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10011-4934
Mailing Address - Country:US
Mailing Address - Phone:212-807-0950
Mailing Address - Fax:212-243-1568
Practice Address - Street 1:227 9TH AVE
Practice Address - Street 2:GRISTEDES PHARMACY 545
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-4934
Practice Address - Country:US
Practice Address - Phone:212-807-0950
Practice Address - Fax:212-243-1568
Is Sole Proprietor?:No
Enumeration Date:2008-02-13
Last Update Date:2021-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046100183500000X
PARP447633183500000X
NJ28RI03573000183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist