Provider Demographics
NPI:1710538129
Name:ROBERTS, BREEANNE NICOLE (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:BREEANNE
Middle Name:NICOLE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7800 CONTEE RD APT 227
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20707-9218
Mailing Address - Country:US
Mailing Address - Phone:313-550-1779
Mailing Address - Fax:
Practice Address - Street 1:7501 BALTIMORE AVE STE 1
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-3651
Practice Address - Country:US
Practice Address - Phone:301-955-1922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-26
Last Update Date:2019-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD26327183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist