Provider Demographics
NPI:1487288957
Name:ROBSON, JENNIFER RAE (PHARMD)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:RAE
Last Name:ROBSON
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 1:517 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:VIROQUA
Mailing Address - State:WI
Mailing Address - Zip Code:54665-1453
Mailing Address - Country:US
Mailing Address - Phone:608-637-8408
Mailing Address - Fax:608-637-8484
Practice Address - Street 1:517 N MAIN ST
Practice Address - Street 2:
Practice Address - City:VIROQUA
Practice Address - State:WI
Practice Address - Zip Code:54665-1453
Practice Address - Country:US
Practice Address - Phone:608-637-8408
Practice Address - Fax:608-637-8484
Is Sole Proprietor?:No
Enumeration Date:2020-02-24
Last Update Date:2020-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI18468-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist