Provider Demographics
NPI:1972605400
Name:ROBERTS, JILL ANNE (PHARMD)
Entity type:Individual
Prefix:MISS
First Name:JILL
Middle Name:ANNE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JILL
Other - Middle Name:ROBERTS
Other - Last Name:GRAVES
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:6283 CHULA VISTA RD
Mailing Address - Street 2:
Mailing Address - City:SOUTHSIDE
Mailing Address - State:AL
Mailing Address - Zip Code:35907-5650
Mailing Address - Country:US
Mailing Address - Phone:256-442-2348
Mailing Address - Fax:
Practice Address - Street 1:3331 RAINBOW DR
Practice Address - Street 2:
Practice Address - City:RAINBOW CITY
Practice Address - State:AL
Practice Address - Zip Code:35906-6205
Practice Address - Country:US
Practice Address - Phone:256-442-7275
Practice Address - Fax:256-442-3633
Is Sole Proprietor?:No
Enumeration Date:2006-09-04
Last Update Date:2021-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL14455183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist