Provider Demographics
NPI:1508190349
Name:ROBERTSON, CASEY
Entity Type:Individual
Prefix:DR
First Name:CASEY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4801 HIGHWAY 58
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37416-1826
Mailing Address - Country:US
Mailing Address - Phone:423-899-3353
Mailing Address - Fax:
Practice Address - Street 1:4801 HIGHWAY 58
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37416-1826
Practice Address - Country:US
Practice Address - Phone:423-899-3353
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-09-27
Last Update Date:2009-09-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN26654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist