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NPI Code Detail

MEDICARE: MR. JAY ROBERTS

MEDICARE: MR. JAY ROBERTS
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
1183500000XPharmacistS007461AZ

General Provider Information

NPI Number : 1801126974
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. JAY ROBERTS
Provider Business Mailing Address
First Line : 1995 W HWY 89A
Second Line :
City : SEDONA
State : AZ
Zip : 86336-5531
Country : US
Telephone Number : 928-282-3903
Fax Number :
Provider Business Practice Location Address
First Line : 1995 W HWY 89A
Second Line :
City : SEDONA
State : AZ
Zip : 86336-5531
Country : US
Telephone Number : 928-282-3903
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/12/2010
Last Update Date : 01/12/2010

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Directions to “ MR. JAY ROBERTS ” Practice Location

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