Healthcare Provider Details

I. General information

NPI: 1104221423
Provider Name (Legal Business Name): JAYSON ROBERTSON PHARM D
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/29/2014
Last Update Date: 10/29/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 W IRON SPRINGS RD STE D
PRESCOTT AZ
86305-1614
US

IV. Provider business mailing address

1151 W IRON SPRINGS RD STE D
PRESCOTT AZ
86305-1614
US

V. Phone/Fax

Practice location:
  • Phone: 928-708-0025
  • Fax: 928-708-0288
Mailing address:
  • Phone: 928-708-0025
  • Fax: 928-708-0288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberS018579
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: