Provider Demographics
NPI:1417234352
Name:ROBOTHAM, MARY K (RPH, PHARMD)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:K
Last Name:ROBOTHAM
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:475 HARTFORD RD
Mailing Address - Street 2:
Mailing Address - City:NEW BRITAIN
Mailing Address - State:CT
Mailing Address - Zip Code:06053-1524
Mailing Address - Country:US
Mailing Address - Phone:860-348-9163
Mailing Address - Fax:860-348-9163
Practice Address - Street 1:475 HARTFORD RD
Practice Address - Street 2:
Practice Address - City:NEW BRITAIN
Practice Address - State:CT
Practice Address - Zip Code:06053-1524
Practice Address - Country:US
Practice Address - Phone:860-348-9163
Practice Address - Fax:860-348-9163
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT09373183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist