Provider Demographics
NPI:1568723054
Name:ROBERTSON, JEFFREY (PHARMD)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 HILLDALE WAY
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53705-2644
Mailing Address - Country:US
Mailing Address - Phone:608-807-3979
Mailing Address - Fax:608-807-3989
Practice Address - Street 1:750 HILLDALE WAY
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53705-2644
Practice Address - Country:US
Practice Address - Phone:608-807-3979
Practice Address - Fax:608-807-3989
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-31
Last Update Date:2012-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14481-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist