Provider Demographics
NPI:1386397743
Name:ROBERTS, DENISE MARIE (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DENISE
Middle Name:MARIE
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 1:219 PARK DR APT 44
Mailing Address - Street 2:
Mailing Address - City:BOSTON
Mailing Address - State:MA
Mailing Address - Zip Code:02215-4760
Mailing Address - Country:US
Mailing Address - Phone:317-258-0371
Mailing Address - Fax:
Practice Address - Street 1:99 HARVARD ST
Practice Address - Street 2:
Practice Address - City:BROOKLINE
Practice Address - State:MA
Practice Address - Zip Code:02446-6403
Practice Address - Country:US
Practice Address - Phone:617-731-4536
Practice Address - Fax:617-731-9140
Is Sole Proprietor?:No
Enumeration Date:2022-01-26
Last Update Date:2022-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH240525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist