1841568656 NPI number — DR. JOSEPH M ROBERTSON PHARM D

Table of content: DR. JOSEPH M ROBERTSON PHARM D (NPI 1841568656)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1841568656 NPI number — DR. JOSEPH M ROBERTSON PHARM D

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON
Provider First Name:
JOSEPH
Provider Middle Name:
M
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM D
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1841568656
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
01/20/2025
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
28 JORDAN RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ELLISVILLE
Provider Business Mailing Address State Name:
MS
Provider Business Mailing Address Postal Code:
39437-8268
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
601-498-7866
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 N MAGNOLIA ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAUREL
Provider Business Practice Location Address State Name:
MS
Provider Business Practice Location Address Postal Code:
39440-3559
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
601-428-4334
Provider Business Practice Location Address Fax Number:
601-428-1898
Provider Enumeration Date:
12/07/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  E-09199 , registered in the state of MS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: E-09199 . This is a "PHARMACY BOARD" identifier , issued by the state of ( MS ) . This identifiers is of the category "OTHER".




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