Provider Demographics
NPI:1861938805
Name:ROBERTSON, SUSAN WILLIAMS
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:WILLIAMS
Last Name:ROBERTSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:566 US HIGHWAY 70 W
Mailing Address - Street 2:
Mailing Address - City:HAVELOCK
Mailing Address - State:NC
Mailing Address - Zip Code:28532-9569
Mailing Address - Country:US
Mailing Address - Phone:252-444-0885
Mailing Address - Fax:252-444-8736
Practice Address - Street 1:566 US HIGHWAY 70 W
Practice Address - Street 2:
Practice Address - City:HAVELOCK
Practice Address - State:NC
Practice Address - Zip Code:28532-9569
Practice Address - Country:US
Practice Address - Phone:252-444-0885
Practice Address - Fax:252-444-8736
Is Sole Proprietor?:No
Enumeration Date:2017-01-15
Last Update Date:2017-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC11610183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist