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NPI Code Detail

MEDICARE: DR. DUSTIN MICHAEL ROBERTS PHARMD

MEDICARE: DR. DUSTIN MICHAEL ROBERTS PHARMD
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
1183500000XPharmacist26022123AIN
21835P0018XPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist26022123AIN

General Provider Information

NPI Number : 1740826049
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. DUSTIN MICHAEL ROBERTS PHARMD
Provider Business Mailing Address
First Line : 5960 CASTLEWAY WEST DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-1977
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5960 CASTLEWAY WEST DR
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46250-1977
Country : US
Telephone Number : 317-579-8434
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/21/2019
Last Update Date : 11/21/2019

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