Provider Demographics
NPI:1861751836
Name:ROBERTS, MIEN MEISIE (PHARMACIST)
Entity type:Individual
Prefix:
First Name:MIEN
Middle Name:MEISIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3737 UNIVERSITY BLVD W
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-2123
Mailing Address - Country:US
Mailing Address - Phone:301-933-6165
Mailing Address - Fax:301-933-6185
Practice Address - Street 1:10 MONOCACY BLVD
Practice Address - Street 2:
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21704-7256
Practice Address - Country:US
Practice Address - Phone:301-644-1482
Practice Address - Fax:301-644-1501
Is Sole Proprietor?:No
Enumeration Date:2012-05-11
Last Update Date:2019-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD205131835P0018X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
No183500000XPharmacy Service ProvidersPharmacist