Provider Demographics
NPI:1538236856
Name:OLIVER, ROBERT TIMOTHY (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:TIMOTHY
Last Name:OLIVER
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 1:125 LOST LAKE RD
Mailing Address - Street 2:
Mailing Address - City:CARROLLTON
Mailing Address - State:GA
Mailing Address - Zip Code:30116-4858
Mailing Address - Country:US
Mailing Address - Phone:770-834-8450
Mailing Address - Fax:
Practice Address - Street 1:623 DIXIE ST
Practice Address - Street 2:
Practice Address - City:CARROLLTON
Practice Address - State:GA
Practice Address - Zip Code:30117-3816
Practice Address - Country:US
Practice Address - Phone:770-834-3393
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-30
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH013862183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist