Provider Demographics
NPI:1720202641
Name:ROBERTSON, LUANN COWAN (RPH)
Entity Type:Individual
Prefix:MRS
First Name:LUANN
Middle Name:COWAN
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2325 GOLFSIDE DR
Mailing Address - Street 2:
Mailing Address - City:LEBANON
Mailing Address - State:IN
Mailing Address - Zip Code:46052-8177
Mailing Address - Country:US
Mailing Address - Phone:765-482-1600
Mailing Address - Fax:765-482-1860
Practice Address - Street 1:112 N LEBANON ST
Practice Address - Street 2:
Practice Address - City:LEBANON
Practice Address - State:IN
Practice Address - Zip Code:46052-2151
Practice Address - Country:US
Practice Address - Phone:765-482-0180
Practice Address - Fax:765-482-1860
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26014265A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN1521651OtherNABP