Basic Information
| Provider Information | |||||||||
| NPI: | 1467822486 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROBINSON | ||||||||
| FirstName: | JAKARTA | ||||||||
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| Credential: | PHARM.D | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4226 OAKWOOD AVE NW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358104066 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 4226 OAKWOOD AVE NW | ||||||||
| Address2: | |||||||||
| City: | HUNTSVILLE | ||||||||
| State: | AL | ||||||||
| PostalCode: | 358104066 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2563612087 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/02/2015 | ||||||||
| LastUpdateDate: | 10/02/2015 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 17189 | AL | Y | Pharmacy Service Providers | Pharmacist | 183500000X | 019833 | LA | N | Pharmacy Service Providers | Pharmacist |
No ID Information.