Provider Demographics
NPI:1134427255
Name:ROBERTSON, JENNIFER RILEY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:RILEY
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 1:13813 TUCKBOROUGH RD
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-3401
Mailing Address - Country:US
Mailing Address - Phone:225-288-2878
Mailing Address - Fax:
Practice Address - Street 1:4510 AMBASSADOR CAFFERY PKWY
Practice Address - Street 2:
Practice Address - City:LAFAYETTE
Practice Address - State:LA
Practice Address - Zip Code:70508-6931
Practice Address - Country:US
Practice Address - Phone:337-988-7290
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2011-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA019254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist