Provider Demographics
NPI:1942846068
Name:ROBERSON, ANITA JO (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANITA
Middle Name:JO
Last Name:ROBERSON
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 1:502 MOUNTAIN VIEW ST
Mailing Address - Street 2:
Mailing Address - City:BISMARCK
Mailing Address - State:AR
Mailing Address - Zip Code:71929-6096
Mailing Address - Country:US
Mailing Address - Phone:501-620-6329
Mailing Address - Fax:
Practice Address - Street 1:414 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72015-3714
Practice Address - Country:US
Practice Address - Phone:501-315-7700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-24
Last Update Date:2019-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD08766183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist