1932495017 NPI number — MRS. JESSICA DAVIS ROBERTSON PHARMD

Table of content: MRS. JESSICA DAVIS ROBERTSON PHARMD (NPI 1932495017)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1932495017 NPI number — MRS. JESSICA DAVIS ROBERTSON PHARMD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ROBERTSON
Provider First Name:
JESSICA
Provider Middle Name:
DAVIS
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
DAVIS
Provider Other First Name:
JESSICA
Provider Other Middle Name:
RENEE'
Provider Other Name Prefix Text:
MISS
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1932495017
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
06/27/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7942 WINCHESTER RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MEMPHIS
Provider Business Mailing Address State Name:
TN
Provider Business Mailing Address Postal Code:
38125-2306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
901-758-3615
Provider Business Mailing Address Fax Number:
901-758-3616

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7942 WINCHESTER RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MEMPHIS
Provider Business Practice Location Address State Name:
TN
Provider Business Practice Location Address Postal Code:
38125-2306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
901-758-3615
Provider Business Practice Location Address Fax Number:
901-758-3616
Provider Enumeration Date:
06/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  33735 , registered in the state of TN ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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