Roberts Drug Store, LLC

Primary specialty

Community/Retail PharmacyTaxonomy code 3336C0003X

License

2018007651 Issued in MO

Legal business name

ROBERTS DRUG STORE, LLC

Practice address

3501 W Truman Blvd
Suite H
Jefferson City, MO 65109-5715

Phone

(573) 556-5551

Fax

(573) 556-5552

NPI assigned

Sep 20, 2010

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mrs. Kimberly Ann RobertsNPI 1578361218

Title

Pharmacist in Charge

Phone

(573) 821-2438

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Enrolled in MO2 enrollments

Enrollment records 2

These CMS records do not include an NPI. They are shown because their name and street address match this provider’s.

Medicare medical equipment & supply locations

Tax ID family

Pyramid Pharmacy LLC2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

Organizations that report the same tax identification number in the National Provider Directory.

• Pyramid Pharmacy, LLC

  • Long Term Care Pharmacy
  • Jefferson City, MO
  • NPI 1881057677
  NPD tax ID

Locations

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

• Kimberly Ann Roberts

  • Pharmacist
  • Jefferson City, MO
  • NPI 1578361218
  NPD Authorized official

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1284940800000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1520640000000",
    "number": "1811205271",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3501 W TRUMAN BLVD",
            "address_2": "SUITE H",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095715",
            "telephone_number": "573-556-5551",
            "fax_number": "573-556-5552"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3501 W TRUMAN BLVD",
            "address_2": "SUITE H",
            "city": "JEFFERSON CITY",
            "state": "MO",
            "postal_code": "651095715",
            "telephone_number": "573-556-5551",
            "fax_number": "573-556-5552"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ROBERTS DRUG STORE, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2010-09-20",
        "last_updated": "2018-03-10",
        "status": "A",
        "authorized_official_last_name": "ROBERTS",
        "authorized_official_first_name": "KIMBERLY",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PHARMACIST IN CHARGE",
        "authorized_official_telephone_number": "573-821-2438",
        "authorized_official_name_prefix": "Mrs."
    },
    "taxonomies": [
        {
            "code": "3336C0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Community/Retail Pharmacy",
            "state": "MO",
            "license": "2018007651",
            "primary": true
        },
        {
            "code": "3336L0003X",
            "taxonomy_group": "",
            "desc": "Pharmacy, Long Term Care Pharmacy",
            "state": "MO",
            "license": "2018007651",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "606488302",
            "state": "MO"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Robert Ritchey
• Riyan Dental LLC
• Nicole Brook Roach, PTA, LMT
• Alane Elizabeth Roath, LPC
• Thomas D. Robbins, M.D.
• E. Dwain Roberts, M.D.
• Emily Louise Roberts, CPNP
• Jonathan M. Roberts, M.D.
• Kimberly Ann Roberts
• Sarah Lillian Roberts, MD

• Community/Retail Pharmacy in Jefferson City, MO
• Providers in Jefferson City, MO by specialty
• Community/Retail Pharmacy in Missouri

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 10, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.