Provider Demographics
NPI:1275834210
Name:ROBINSON, JESSE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JESSE
Middle Name:
Last Name:ROBINSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2650 11TH AVE
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NE
Mailing Address - Zip Code:69162-2471
Mailing Address - Country:US
Mailing Address - Phone:307-350-2419
Mailing Address - Fax:
Practice Address - Street 1:1944 ILLINOIS ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NE
Practice Address - Zip Code:69162-1427
Practice Address - Country:US
Practice Address - Phone:308-254-4767
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2010-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE13464183500000X
WY3379183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist