Provider Demographics
NPI:1497348544
Name:ROBERTS, ANITA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25311 147TH DR
Mailing Address - Street 2:
Mailing Address - City:ROSEDALE
Mailing Address - State:NY
Mailing Address - Zip Code:11422-2823
Mailing Address - Country:US
Mailing Address - Phone:516-262-0072
Mailing Address - Fax:
Practice Address - Street 1:209 W RIDGEWOOD AVE # 2B
Practice Address - Street 2:
Practice Address - City:PLEASANTVILLE
Practice Address - State:NJ
Practice Address - Zip Code:08232-3739
Practice Address - Country:US
Practice Address - Phone:516-262-0072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-18
Last Update Date:2021-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes372600000XNursing Service Related ProvidersAdult Companion