Provider Demographics
NPI:1033779228
Name:ROBERTSON, AMY
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3117 N HWY 81
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-9283
Mailing Address - Country:US
Mailing Address - Phone:580-252-0140
Mailing Address - Fax:580-252-0143
Practice Address - Street 1:3117 N HWY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-9283
Practice Address - Country:US
Practice Address - Phone:580-252-0140
Practice Address - Fax:580-252-0143
Is Sole Proprietor?:No
Enumeration Date:2019-06-19
Last Update Date:2019-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
174H00000X
OK151211835G0303X, 1835N1003X, 208U00000X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174H00000XOther Service ProvidersHealth Educator
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835N1003XPharmacy Service ProvidersPharmacistNutrition Support
No208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology