Provider Demographics
NPI:1922525377
Name:ROBOSKI, GEENA ELIZABETH NELLIS (PHARMD)
Entity Type:Individual
Prefix:MRS
First Name:GEENA
Middle Name:ELIZABETH NELLIS
Last Name:ROBOSKI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:MS
Other - First Name:GEENA
Other - Middle Name:ELIZABETH
Other - Last Name:NELLIS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1541 KINGS HWY
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71103-4228
Mailing Address - Country:US
Mailing Address - Phone:318-626-0849
Mailing Address - Fax:
Practice Address - Street 1:1541 KINGS HWY
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71103-4228
Practice Address - Country:US
Practice Address - Phone:318-626-0849
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-08-26
Last Update Date:2019-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-15071183500000X
LA022206183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LAMA.003487OtherLOUISIANA BOARD OF PHARMACY-IMMUNIZATION
MSE-15071OtherMISSISSIPPI BOARD OF PHARMACY