Provider Demographics
NPI:1861474314
Name:SKINNER, ROBERTA F (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERTA
Middle Name:F
Last Name:SKINNER
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 1:1417 INNSDALE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CASTLE
Mailing Address - State:IN
Mailing Address - Zip Code:47362-1761
Mailing Address - Country:US
Mailing Address - Phone:765-521-2031
Mailing Address - Fax:
Practice Address - Street 1:501 BROAD ST
Practice Address - Street 2:
Practice Address - City:NEW CASTLE
Practice Address - State:IN
Practice Address - Zip Code:47362-4851
Practice Address - Country:US
Practice Address - Phone:765-529-5808
Practice Address - Fax:765-521-7124
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-11-18
Last Update Date:2008-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26021231A183500000X
MI5302023654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered183500000XPharmacy Service ProvidersPharmacist