Detra Lynn Robertson, PHARM.D.
Individual provider Active NPI Pharmacist · New Tazewell, TN
NPI 1558490482 · NPPES record last updated Nov 16, 2023
Key facts
- NPI
- 1558490482
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- 10870 (TN)
- Practice address
- 915 N Broad St
New Tazewell, TN 37825-6633 - Phone
- (423) 626-5511
- NPI assigned
- Mar 5, 2007
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 1
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Peytliv Inc | Current | Accepting new patients |
Locations
915 N Broad St
New Tazewell, TN 37825
Phone (423) 626-5511
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | 10870 | TN | Yes |
Addresses
Primary practice location
915 N Broad St
New Tazewell, TN 37825-6633
Mailing address
PO Box 4298
Harrogate, TN 37752-4298
Phone (865) 585-1136
Other providers in New Tazewell, TN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Nov 16, 2023. 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.