Provider Demographics
NPI:1104221423
Name:ROBERTSON, JAYSON (PHARM D)
Entity Type:Individual
Prefix:
First Name:JAYSON
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1151 W IRON SPRINGS RD STE D
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1614
Mailing Address - Country:US
Mailing Address - Phone:928-708-0025
Mailing Address - Fax:928-708-0288
Practice Address - Street 1:1151 W IRON SPRINGS RD STE D
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1614
Practice Address - Country:US
Practice Address - Phone:928-708-0025
Practice Address - Fax:928-708-0288
Is Sole Proprietor?:No
Enumeration Date:2014-10-29
Last Update Date:2014-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018579183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist