Provider Demographics
NPI:1962793596
Name:ROBERTS, GEORGIA LEIGH (RPH)
Entity type:Individual
Prefix:MISS
First Name:GEORGIA
Middle Name:LEIGH
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:37 SUNSET DR
Mailing Address - Street 2:
Mailing Address - City:WAYNESBORO
Mailing Address - State:VA
Mailing Address - Zip Code:22980-7413
Mailing Address - Country:US
Mailing Address - Phone:540-292-2611
Mailing Address - Fax:
Practice Address - Street 1:501 N COALTER ST
Practice Address - Street 2:
Practice Address - City:STAUNTON
Practice Address - State:VA
Practice Address - Zip Code:24401-3402
Practice Address - Country:US
Practice Address - Phone:540-886-2775
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-30
Last Update Date:2011-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009435183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist