Provider Demographics
NPI:1487989422
Name:ROBERTSON, KIMBERLEY ANN (PHARMD)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:ANN
Last Name:ROBERTSON
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 1:941 DURHAM RD
Mailing Address - Street 2:
Mailing Address - City:WAKE FOREST
Mailing Address - State:NC
Mailing Address - Zip Code:27587-8794
Mailing Address - Country:US
Mailing Address - Phone:919-570-3249
Mailing Address - Fax:919-570-3250
Practice Address - Street 1:941 DURHAM RD
Practice Address - Street 2:
Practice Address - City:WAKE FOREST
Practice Address - State:NC
Practice Address - Zip Code:27587-8794
Practice Address - Country:US
Practice Address - Phone:919-570-3249
Practice Address - Fax:919-570-3250
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-08
Last Update Date:2009-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC18555183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0920802Medicaid