Healthcare Provider Details

I. General information

NPI: 1598808560
Provider Name (Legal Business Name): SHANTA LORIEN ROBERTS PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/15/2007
Last Update Date: 10/30/2025
Certification Date: 10/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

616 MARKET ST
MEDFORD OR
97504-6126
US

IV. Provider business mailing address

1112 LUZON LN
GRANTS PASS OR
97527-5213
US

V. Phone/Fax

Practice location:
  • Phone: 541-451-7565
  • Fax:
Mailing address:
  • Phone: 541-451-7565
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number10845
License Number StateOR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: