Individual
JOHNNY Q ROBERTS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
D.PH.
Contact information
Practice address
1016 E. RAY FINE BLVD., SUITE 100, ROLAND, OK 74954
(918) 427-0400
Mailing address
PO BOX 1600, ROLAND, OK 74954-1600
(918) 427-0400
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
10891
OK
Other
Enumeration date
08/16/2006
Last updated
07/08/2007
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