Provider Demographics
NPI:1063184059
Name:ROBERTSON, YVETTE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:YVETTE
Middle Name:
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:MRS
Other - First Name:YVETTE
Other - Middle Name:
Other - Last Name:ROBERTSON
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RPH
Mailing Address - Street 1:2406 W BRAMBLE BERRY LN
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85085-7024
Mailing Address - Country:US
Mailing Address - Phone:623-640-6295
Mailing Address - Fax:
Practice Address - Street 1:2406 W BRAMBLE BERRY LN
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85085-7024
Practice Address - Country:US
Practice Address - Phone:623-640-6295
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013877183500000X
LAPST.021553183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist