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NPI Code Detail

MEDICARE: MRS. KRISTIANA DIANNE ROBERTS RPH

MEDICARE:  MRS. KRISTIANA DIANNE ROBERTS  RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist26017309IN

General Provider Information

NPI Number : 1154925097
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. KRISTIANA DIANNE ROBERTS RPH
Provider Business Mailing Address
First Line : 1725 SALEM ST
Second Line :
City : LAFAYETTE
State : IN
Zip : 47904-2105
Country : US
Telephone Number : 765-447-1276
Fax Number : 765-447-3492
Provider Business Practice Location Address
First Line : 1725 SALEM ST
Second Line :
City : LAFAYETTE
State : IN
Zip : 47904-2105
Country : US
Telephone Number : 765-447-1276
Fax Number : 765-447-3492
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/22/2020
Last Update Date : 11/22/2020

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Directions to “ MRS. KRISTIANA DIANNE ROBERTS RPH” Practice Location

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