Provider Demographics
NPI:1679585483
Name:ROBERTSON, DAVID BRUCE (RPH)
Entity type:Individual
Prefix:MR
First Name:DAVID
Middle Name:BRUCE
Last Name:ROBERTSON
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 COUNTRY DR
Mailing Address - Street 2:
Mailing Address - City:WORLAND
Mailing Address - State:WY
Mailing Address - Zip Code:82401-3104
Mailing Address - Country:US
Mailing Address - Phone:307-347-8393
Mailing Address - Fax:
Practice Address - Street 1:100 S 20TH ST
Practice Address - Street 2:
Practice Address - City:WORLAND
Practice Address - State:WY
Practice Address - Zip Code:82401-3742
Practice Address - Country:US
Practice Address - Phone:307-347-2851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-12
Last Update Date:2008-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3046183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist