Individual
MRS. SUSAN ROBERTSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2306 LARCHER BLVD, KEESLER AFB, MS 39534
(228) 377-9791
Mailing address
301 FISHER ST, BX PHARMACY, KEESLER AFB, MS 39534-2508
(228) 377-9791
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
E-07122
MS
Other
Enumeration date
10/27/2011
Last updated
10/27/2011
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