Healthcare Provider Details

I. General information

NPI: 1861751836
Provider Name (Legal Business Name): MIEN MEISIE ROBERTS PHARMACIST
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2012
Last Update Date: 07/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MONOCACY BLVD
FREDERICK MD
21704-7256
US

IV. Provider business mailing address

3737 UNIVERSITY BLVD W
KENSINGTON MD
20895-2123
US

V. Phone/Fax

Practice location:
  • Phone: 301-644-1482
  • Fax: 301-644-1501
Mailing address:
  • Phone: 301-933-6165
  • Fax: 301-933-6185

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number20513
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number20513
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: