Jordan Robertson
Individual provider Active NPI Pharmacist · Cuba, MO
NPI 1366043846 · NPPES record last updated Nov 3, 2020
Key facts
- NPI
- 1366043846
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 2015025631 (MO)
- Practice address
- 100 Ozark Dr
Cuba, MO 65453-1664 - Phone
- (573) 885-2515
- NPI assigned
- Nov 3, 2020
- Sex
- Male
- Sole proprietor
- Yes
Organizations & group practices 2
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2015025631 | MO | MD | Pharmacist |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Wal-Mart Stores East, LP | Past |
Accepting new patients | |
| Wal-Mart Stores East LP | Past |
Accepting new patients |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 2015025631 | MO | Yes |
Addresses
Primary practice location
100 Ozark Dr
Cuba, MO 65453-1664
Mailing address
3660 Highway T
Rosebud, MO 63091-1803
Other providers in Cuba, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 3, 2020. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.