Provider Demographics
NPI:1841568656
Name:ROBERTSON, JOSEPH M (PHARM D)
Entity type:Individual
Prefix:DR
First Name:JOSEPH
Middle Name:M
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28 JORDAN RD
Mailing Address - Street 2:
Mailing Address - City:ELLISVILLE
Mailing Address - State:MS
Mailing Address - Zip Code:39437-8268
Mailing Address - Country:US
Mailing Address - Phone:601-498-7866
Mailing Address - Fax:
Practice Address - Street 1:520 N MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MS
Practice Address - Zip Code:39440-3559
Practice Address - Country:US
Practice Address - Phone:601-428-4334
Practice Address - Fax:601-428-1898
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-07
Last Update Date:2025-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-09199183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MSE-09199OtherPHARMACY BOARD