Provider Demographics
NPI:1417339979
Name:ROBERTSON, JOHANNA DANIELLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOHANNA
Middle Name:DANIELLE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 DR. ML KING JR. BLVD.
Mailing Address - Street 2:
Mailing Address - City:NEW BERN
Mailing Address - State:NC
Mailing Address - Zip Code:28562-2226
Mailing Address - Country:US
Mailing Address - Phone:252-672-8354
Mailing Address - Fax:252-672-8359
Practice Address - Street 1:3500 DR. ML KING JR. BLVD.
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-2226
Practice Address - Country:US
Practice Address - Phone:252-672-8354
Practice Address - Fax:252-672-8359
Is Sole Proprietor?:No
Enumeration Date:2015-06-22
Last Update Date:2015-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC25100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist