Active NPI
Stephen Ezra Robertson, PHARM.D.
- Pharmacist
- Union Gap, WA
National Provider Identifier
1831594902
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- License
- PH 60497079
- Practice address
- 2310 Longfibre Ave
Union Gap, WA 98903-1513 - Phone
- (509) 454-5249
- Fax
- (509) 454-5246
- NPI assigned
- Oct 30, 2014
- Sex
- Male
- 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 | PH 60497079 | WA | Primary |
Addresses
Primary practice location
2310 Longfibre Ave
Union Gap, WA 98903-1513
Mailing address
2310 Longfibre Ave
Union Gap, WA 98903-1513
Phone (509) 454-5249
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
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| PH 60497079 | WA | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1414627200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1422230400000",
"number": "1831594902",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2310 LONGFIBRE AVE",
"city": "UNION GAP",
"state": "WA",
"postal_code": "989031513",
"telephone_number": "509-454-5249",
"fax_number": "509-454-5246"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2310 LONGFIBRE AVE",
"city": "UNION GAP",
"state": "WA",
"postal_code": "989031513",
"telephone_number": "509-454-5249",
"fax_number": "509-454-5246"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROBERTSON",
"first_name": "STEPHEN",
"middle_name": "EZRA",
"name_prefix": "Mr.",
"credential": "PHARM.D.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2014-10-30",
"last_updated": "2015-01-26",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "WA",
"license": "PH 60497079",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Union Gap, WA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 26, 2015; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.