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General NPI Number Information
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NPI Number | 1881208544
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Entity Type | Individual
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Provider Name | NA'DRA NIKESHA ROBERTSON PHARMD
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Gender | Female
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Dates
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Enumeration Date | 09/01/2020
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Last Update Date | 09/01/2020
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Provider Practice Location Address
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Address Line | 9010 N 121ST EAST AVE
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City | OWASSO
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State | OK
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Zip | 74055-5358
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Country | US
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Telephone | 918-401-8001
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Fax |
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Provider Business Mailing Address
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Address Line | 5210 E 81ST ST APT 132
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City | TULSA
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State | OK
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Zip | 74137-2248
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Country | US
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Telephone | 501-504-5043
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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 | 18912
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License Number State | OK
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