Provider Demographics
NPI:1881208544
Name:ROBERTSON, NA'DRA NIKESHA (PHARMD)
Entity Type:Individual
Prefix:
First Name:NA'DRA
Middle Name:NIKESHA
Last Name:ROBERTSON
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 1:5210 E 81ST ST APT 132
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74137-2248
Mailing Address - Country:US
Mailing Address - Phone:501-504-5043
Mailing Address - Fax:
Practice Address - Street 1:9010 N 121ST EAST AVE
Practice Address - Street 2:
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-5358
Practice Address - Country:US
Practice Address - Phone:918-401-8001
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-01
Last Update Date:2020-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK18912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist