Provider Demographics
NPI:1578164315
Name:ROBERTS, PATRICIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:PATRICIA
Middle Name:
Last Name:ROBERTS
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 1:6903 DAY BREAK CT
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40272-3896
Mailing Address - Country:US
Mailing Address - Phone:502-939-6701
Mailing Address - Fax:
Practice Address - Street 1:6903 DAY BREAK CT
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40272-3896
Practice Address - Country:US
Practice Address - Phone:502-939-6701
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-06
Last Update Date:2020-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY12532183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY12532OtherSTATE PHARMACIST LICENSE NUMBER
204844OtherNABP ID