Active NPI
Suzanne Ruth Roberts
- Pharmacist
- Jeffersonville, IN
National Provider Identifier
1003584558
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- 26015289A
- Practice address
- 5653 Bailey Grant Rd
Jeffersonville, IN 47130-8608 - Phone
- (502) 558-4307
- NPI assigned
- Aug 31, 2021
- Sex
- Female
- Sole proprietor
- No
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 | 26015289A | IN | Primary |
Addresses
Primary practice location
5653 Bailey Grant Rd
Jeffersonville, IN 47130-8608
Mailing address
5653 Bailey Grant Rd
Jeffersonville, IN 47130-8608
Phone (502) 558-4307
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 |
|---|---|---|---|
| 26015289A | IN | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1630368000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1630368000000",
"number": "1003584558",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "5653 BAILEY GRANT RD",
"city": "JEFFERSONVILLE",
"state": "IN",
"postal_code": "471308608",
"telephone_number": "502-558-4307"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "5653 BAILEY GRANT RD",
"city": "JEFFERSONVILLE",
"state": "IN",
"postal_code": "471308608",
"telephone_number": "502-558-4307"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTS",
"first_name": "SUZANNE",
"middle_name": "RUTH",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-08-31",
"last_updated": "2021-08-31",
"certification_date": "2021-08-31",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IN",
"license": "26015289A",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Jeffersonville, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 31, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.