Provider Demographics
NPI:1376866475
Name:ROBERTSON, MARY BETH (PHARM D)
Entity Type:Individual
Prefix:
First Name:MARY BETH
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
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 1:358 E. CASS ST
Mailing Address - Street 2:
Mailing Address - City:JOLIET
Mailing Address - State:IL
Mailing Address - Zip Code:60432
Mailing Address - Country:US
Mailing Address - Phone:815-727-0033
Mailing Address - Fax:
Practice Address - Street 1:358 E CASS ST
Practice Address - Street 2:
Practice Address - City:JOLIET
Practice Address - State:IL
Practice Address - Zip Code:60432-2835
Practice Address - Country:US
Practice Address - Phone:815-727-0033
Practice Address - Fax:815-727-5398
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2011-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051291755183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist