Provider Demographics
NPI:1962409789
Name:ROBERSON, LISA MARIE (PHARM D)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:MARIE
Last Name:ROBERSON
Suffix:
Gender:F
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 1:1819 WOODBROOK CIR
Mailing Address - Street 2:
Mailing Address - City:ALABASTER
Mailing Address - State:AL
Mailing Address - Zip Code:35007-7028
Mailing Address - Country:US
Mailing Address - Phone:205-621-0069
Mailing Address - Fax:205-621-1774
Practice Address - Street 1:205 BUCK CREEK PLZ
Practice Address - Street 2:
Practice Address - City:ALABASTER
Practice Address - State:AL
Practice Address - Zip Code:35007-7004
Practice Address - Country:US
Practice Address - Phone:205-621-0069
Practice Address - Fax:205-621-1774
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist