Provider Demographics
NPI:1902211550
Name:ROBERTS, LAURA ANN (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LAURA
Middle Name:ANN
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:PO BOX 809
Mailing Address - Street 2:
Mailing Address - City:ALBANY
Mailing Address - State:KY
Mailing Address - Zip Code:42602-0809
Mailing Address - Country:US
Mailing Address - Phone:606-557-1213
Mailing Address - Fax:606-575-1215
Practice Address - Street 1:190 WESTVIEW SHOPPING CTR
Practice Address - Street 2:
Practice Address - City:ALBANY
Practice Address - State:KY
Practice Address - Zip Code:42602-1600
Practice Address - Country:US
Practice Address - Phone:606-557-1213
Practice Address - Fax:606-557-1215
Is Sole Proprietor?:No
Enumeration Date:2014-06-23
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY16505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ057139Medicaid
KY7100244750Medicaid