Provider Demographics
NPI:1154447944
Name:ROBERTSON, ELIZABETH A (RPH)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:ROBERTSON
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 1:13 CROSS ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:NH
Mailing Address - Zip Code:03079-3708
Mailing Address - Country:US
Mailing Address - Phone:603-893-5491
Mailing Address - Fax:603-893-5491
Practice Address - Street 1:142 MAIN ST
Practice Address - Street 2:
Practice Address - City:SALEM
Practice Address - State:NH
Practice Address - Zip Code:03079-3106
Practice Address - Country:US
Practice Address - Phone:603-894-4429
Practice Address - Fax:603-894-4851
Is Sole Proprietor?:No
Enumeration Date:2007-03-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NH2237183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist