Provider Demographics
NPI:1033491782
Name:ROBERTS, KATHLEEN MARY (RPH)
Entity Type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MARY
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7 SEQUOIA CT
Mailing Address - Street 2:
Mailing Address - City:MONROE TOWNSHIP
Mailing Address - State:NJ
Mailing Address - Zip Code:08831-4400
Mailing Address - Country:US
Mailing Address - Phone:732-521-4918
Mailing Address - Fax:609-448-3867
Practice Address - Street 1:16 PRINCETON HIGHTSTOWN RD
Practice Address - Street 2:
Practice Address - City:EAST WINDSOR
Practice Address - State:NJ
Practice Address - Zip Code:08520-1909
Practice Address - Country:US
Practice Address - Phone:609-448-3729
Practice Address - Fax:609-448-3867
Is Sole Proprietor?:No
Enumeration Date:2011-09-19
Last Update Date:2011-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI02355300183500000X
NJ28RJ00425183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist