Provider Demographics
NPI:1861653230
Name:ROBERTS, LAUREN MARIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LAUREN
Middle Name:MARIE
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 1:7665 RAVENSRIDGE RD # A2
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63119-5510
Mailing Address - Country:US
Mailing Address - Phone:618-780-3252
Mailing Address - Fax:
Practice Address - Street 1:11G-JB, #1 JEFFERSON BARRACKS DR
Practice Address - Street 2:ST. LOUIS VA MEDICAL CENTER, JEFFERSON BARRACKS DIV.
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63125-4181
Practice Address - Country:US
Practice Address - Phone:314-652-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-06-18
Last Update Date:2008-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008027394183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist