Provider Demographics
NPI:1902320112
Name:ROBERTS, RICHARD AARON (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:AARON
Last Name:ROBERTS
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 1:26180 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:RUIDOSO DOWNS
Mailing Address - State:NM
Mailing Address - Zip Code:88346-9158
Mailing Address - Country:US
Mailing Address - Phone:575-378-5400
Mailing Address - Fax:575-378-5267
Practice Address - Street 1:26180 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:RUIDOSO DOWNS
Practice Address - State:NM
Practice Address - Zip Code:88346-9158
Practice Address - Country:US
Practice Address - Phone:575-378-5400
Practice Address - Fax:575-378-5267
Is Sole Proprietor?:No
Enumeration Date:2017-07-29
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM4366183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist