Provider Demographics
NPI:1508455833
Name:ROBERTSON, NATALIE GAY (CPHT)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:GAY
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:CPHT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14414 US HIGHWAY 87 W
Mailing Address - Street 2:
Mailing Address - City:LA VERNIA
Mailing Address - State:TX
Mailing Address - Zip Code:78121-5922
Mailing Address - Country:US
Mailing Address - Phone:830-779-3109
Mailing Address - Fax:
Practice Address - Street 1:14414 US HIGHWAY 87 W
Practice Address - Street 2:
Practice Address - City:LA VERNIA
Practice Address - State:TX
Practice Address - Zip Code:78121-5922
Practice Address - Country:US
Practice Address - Phone:830-779-3109
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX253946183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician