Colvin Earl Robertson Jr., PHARM.D.

Primary specialty

PharmacistTaxonomy code 183500000X

License

PS36568 Issued in FL

Practice address

13027 State Highway 155 S Ste 200
Tyler, TX 75703-6564

Phone

(430) 562-9003

Fax

(430) 562-9004

NPI assigned

Apr 29, 2016

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Goodvalue Pharmacy LLC

  • Community/Retail Pharmacy
  • Schertz, TX
  • NPI 1629601489
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1461888000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633392000000",
    "number": "1487009205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4801 TROUP HWY STE 402",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757032358",
            "telephone_number": "039-617-6885",
            "fax_number": "903-792-9114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "13027 STATE HIGHWAY 155 S STE 200",
            "city": "TYLER",
            "state": "TX",
            "postal_code": "757036564",
            "telephone_number": "430-562-9003",
            "fax_number": "430-562-9004"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "COLVIN",
        "middle_name": "EARL",
        "name_prefix": "Dr.",
        "name_suffix": "Jr.",
        "credential": "PHARM.D.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2016-04-29",
        "last_updated": "2021-10-05",
        "certification_date": "2021-03-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "TX",
            "license": "48543",
            "primary": false
        },
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "FL",
            "license": "PS36568",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Robyn Liane Roberts, MD
• Ron L Roberts, MS
• Steven Bruce Roberts, MD
• Timothy Duane Roberts, LICENSED PROFESSIONA
• Bradley Robertson, MD
• Edwin D Robertson, PHD
• Dolar Robinett, COTA
• Judith M Robinett, L.P.C.
• Charles Edward Robinson Jr., DDS
• Jaelee R Robinson

• Pharmacist in Tyler, TX
• Providers in Tyler, TX by specialty
• Pharmacist in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 5, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.