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General NPI Number Information
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NPI Number | 1598808560
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Entity Type | Individual
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Provider Name | SHANTA LORIEN ROBERTS PHARMD
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Gender | Female
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Dates
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Enumeration Date | 02/15/2007
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Last Update Date | 10/30/2025
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Provider Practice Location Address
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Address Line | 616 MARKET ST
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City | MEDFORD
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State | OR
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Zip | 97504-6126
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Country | US
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Telephone | 541-451-7565
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Fax |
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Provider Business Mailing Address
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Address Line | 1112 LUZON LN
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City | GRANTS PASS
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State | OR
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Zip | 97527-5213
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Country | US
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Telephone | 541-451-7565
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 10845
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License Number State | OR
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