Individual provider Active NPI

Joseph M Robertson, PHARM D

  • Pharmacist
  • Laurel, MS
National Provider Identifier
1841568656
Registry record updated Jan 20, 2025
On this page

Key facts

NPPES NPI Registry
Primary specialty
PharmacistTaxonomy code 183500000X
License
E-09199 Issued in MS
Practice address
520 N Magnolia St
Laurel, MS 39440-3559
Phone
(601) 428-4334
Fax
(601) 428-1898
NPI assigned
Dec 7, 2011
Sex
Male
Sole proprietor
Yes

NPPES NPI Registry

Updated by the provider on Jan 20, 2025

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist 183500000X E-09199 MS Primary

Addresses

Primary practice location

520 N Magnolia St
Laurel, MS 39440-3559

Mailing address

28 Jordan Rd
Ellisville, MS 39437-8268
Phone (601) 498-7866

Other identifiers 1

IdentifierTypeStateIssuer
E-09199OtherMSPHARMACY BOARD

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

LicenseStateTypeSpecialty
E-09199MSMDPharmacist

Practice roles

OrganizationSpecialtyStatusNew patients
Wallace Drug Company Inc CurrentSince Jan 26, 2025 Accepting new patients
Wallace Drug Company Inc CurrentSince Jan 26, 2025 Accepting new patients

Locations

520 N Magnolia St
Laurel, MS 39440
Phone (601) 428-1277

Organizations & group practices 2

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

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

{
    "created_epoch": "1323216000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1737331200000",
    "number": "1841568656",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "28 JORDAN RD",
            "city": "ELLISVILLE",
            "state": "MS",
            "postal_code": "394378268",
            "telephone_number": "601-498-7866"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "520 N MAGNOLIA ST",
            "city": "LAUREL",
            "state": "MS",
            "postal_code": "394403559",
            "telephone_number": "601-428-4334",
            "fax_number": "601-428-1898"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTSON",
        "first_name": "JOSEPH",
        "middle_name": "M",
        "name_prefix": "Dr.",
        "credential": "PHARM D",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2011-12-07",
        "last_updated": "2025-01-20",
        "certification_date": "2025-01-20",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "MS",
            "license": "E-09199",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "PHARMACY BOARD",
            "identifier": "E-09199",
            "state": "MS"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Laurel, MS

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 20, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.