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NPI Code Detail

MEDICARE: MAUREEN ROBERTSON

MEDICARE: MAUREEN ROBERTSON
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist66381CA

General Provider Information

NPI Number : 1336512276
Entity Type Code : Individual
Provider Name (Legal Business Name) : MAUREEN ROBERTSON
Provider Business Mailing Address
First Line : 6450 PONY EXPRESS TRL
Second Line :
City : POLLOCK PINES
State : CA
Zip : 95726-9601
Country : US
Telephone Number : 530-647-8013
Fax Number : 530-647-1207
Provider Business Practice Location Address
First Line : 6450 PONY EXPRESS TRL
Second Line :
City : POLLOCK PINES
State : CA
Zip : 95726-9601
Country : US
Telephone Number : 530-647-8013
Fax Number : 530-647-1207
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/31/2015
Last Update Date : 10/31/2015

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Directions to “ MAUREEN ROBERTSON ” Practice Location

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