Provider Demographics
NPI:1982204459
Name:ROBERTS, AMI NICHOLE (PHARMD)
Entity Type:Individual
Prefix:
First Name:AMI
Middle Name:NICHOLE
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 1:7207 N M1 HWY
Mailing Address - Street 2:
Mailing Address - City:GLADSTONE
Mailing Address - State:MO
Mailing Address - Zip Code:64119-5351
Mailing Address - Country:US
Mailing Address - Phone:816-468-0045
Mailing Address - Fax:
Practice Address - Street 1:7207 N M1 HWY
Practice Address - Street 2:
Practice Address - City:GLADSTONE
Practice Address - State:MO
Practice Address - Zip Code:64119-5351
Practice Address - Country:US
Practice Address - Phone:816-468-0045
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO045294183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist