Active NPI
Susan Robertson
- Pharmacist
- Keesler Afb, MS
National Provider Identifier
1003192659
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- E-07122
- Practice address
- 2306 Larcher Blvd
Keesler Afb, MS 39534 - Phone
- (228) 377-9791
- NPI assigned
- Oct 27, 2011
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | E-07122 | MS | Primary |
Addresses
Primary practice location
2306 Larcher Blvd
Keesler Afb, MS 39534
Mailing address
301 Fisher St
BX Pharmacy
Keesler Afb, MS 39534-2508
Phone (228) 377-9791
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| E-07122 | MS | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1319673600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1319673600000",
"number": "1003192659",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "301 FISHER ST",
"address_2": "BX PHARMACY",
"city": "KEESLER AFB",
"state": "MS",
"postal_code": "395342508",
"telephone_number": "228-377-9791"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2306 LARCHER BLVD",
"city": "KEESLER AFB",
"state": "MS",
"postal_code": "39534",
"telephone_number": "228-377-9791"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "SUSAN",
"name_prefix": "Mrs.",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2011-10-27",
"last_updated": "2011-10-27",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "MS",
"license": "E-07122",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Keesler Afb, MS
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 27, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.