Provider Demographics
NPI:1366882870
Name:ROBERTSON, LISA KAESE (RPH)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:KAESE
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 RUM RIVER DR N
Mailing Address - Street 2:
Mailing Address - City:PRINCETON
Mailing Address - State:MN
Mailing Address - Zip Code:55371-1616
Mailing Address - Country:US
Mailing Address - Phone:763-389-1411
Mailing Address - Fax:763-389-3170
Practice Address - Street 1:115 RUM RIVER DR N
Practice Address - Street 2:
Practice Address - City:PRINCETON
Practice Address - State:MN
Practice Address - Zip Code:55371-1616
Practice Address - Country:US
Practice Address - Phone:763-389-1411
Practice Address - Fax:763-389-3170
Is Sole Proprietor?:No
Enumeration Date:2013-06-28
Last Update Date:2013-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114391183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist