Jacob Tyler Roberts, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

PHA.0023800 Issued in CO

Practice address

133 Sam Walton LN
Castle Rock, CO 80104-7933

Phone

(303) 688-8335

NPI assigned

Oct 6, 2021

Sex

Male

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Other names 1

• Jake Tyler Roberts Other name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

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

{
    "created_epoch": "1633478400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1633478400000",
    "number": "1881356996",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12148 S WANDERLUST WAY",
            "city": "PARKER",
            "state": "CO",
            "postal_code": "801388857",
            "telephone_number": "702-339-4898"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "133 SAM WALTON LN",
            "city": "CASTLE ROCK",
            "state": "CO",
            "postal_code": "801047933",
            "telephone_number": "303-688-8335"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROBERTS",
        "first_name": "JACOB",
        "middle_name": "TYLER",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-10-06",
        "last_updated": "2021-10-06",
        "certification_date": "2021-10-06",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "CO",
            "license": "PHA.0023800",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JAKE",
            "last_name": "ROBERTS",
            "middle_name": "TYLER",
            "credential": "PHARMD",
            "code": "5",
            "type": "Other Name"
        }
    ]
}

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• Bailey Robertson
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• Rock Internal Medicine PC

• Pharmacist in Castle Rock, CO
• Providers in Castle Rock, CO by specialty
• Pharmacist in Colorado

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 6, 2021; 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.