Healthcare Provider Details

I. General information

NPI: 1952215394
Provider Name (Legal Business Name): DALRON JAMAL ROBERTSON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2026
Last Update Date: 10/01/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

451 E PERSHING RD UNIT 204
CHICAGO IL
60653-0274
US

IV. Provider business mailing address

451 E PERSHING RD UNIT 204
CHICAGO IL
60653-0274
US

V. Phone/Fax

Practice location:
  • Phone: 601-720-0154
  • Fax:
Mailing address:
  • Phone: 601-720-0154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number049266668
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: