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General NPI Number Information
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NPI Number | 1740862176
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Entity Type | Individual
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Provider Name | JARON ROBERTSON
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Gender | Male
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Dates
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Enumeration Date | 04/26/2021
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Last Update Date | 04/26/2021
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Provider Practice Location Address
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Address Line | 6420 19TH ST
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City | LUBBOCK
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State | TX
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Zip | 79407-1406
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Country | US
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Telephone | 806-797-3877
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Fax |
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Provider Business Mailing Address
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Address Line | 3420 MILWAUKEE AVE APT 1328
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City | LUBBOCK
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State | TX
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Zip | 79407-4327
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Country | US
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Telephone | 806-252-5454
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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 | 66800
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License Number State | TX
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