Healthcare Provider Details

I. General information

NPI: 1760840607
Provider Name (Legal Business Name): ALLISON ROBERTS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/07/2016
Last Update Date: 05/21/2026
Certification Date: 05/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

17630 W BLUEMOUND RD
BROOKFIELD WI
53045-2908
US

IV. Provider business mailing address

17630 W BLUEMOUND RD
BROOKFIELD WI
53045-2908
US

V. Phone/Fax

Practice location:
  • Phone: 262-784-2490
  • Fax: 262-784-2507
Mailing address:
  • Phone: 262-784-2490
  • Fax: 262-784-2507

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number18029-40
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: