Provider Demographics
NPI:1104814847
Name:ROBERTS, JANE ANN (PHARMACIST)
Entity type:Individual
Prefix:MRS
First Name:JANE
Middle Name:ANN
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:263 OLD HAROLD RD
Mailing Address - Street 2:
Mailing Address - City:HAROLD
Mailing Address - State:KY
Mailing Address - Zip Code:41635-9036
Mailing Address - Country:US
Mailing Address - Phone:606-478-8584
Mailing Address - Fax:
Practice Address - Street 1:263 OLD HAROLD RD
Practice Address - Street 2:
Practice Address - City:HAROLD
Practice Address - State:KY
Practice Address - Zip Code:41635-9036
Practice Address - Country:US
Practice Address - Phone:606-478-9474
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY8921183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist