Provider Demographics
NPI:1871583112
Name:ROBERTS, JANA MARIE (RPH)
Entity type:Individual
Prefix:MRS
First Name:JANA
Middle Name:MARIE
Last Name:ROBERTS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17877 BULL RUN RD
Mailing Address - Street 2:
Mailing Address - City:LANCASTER
Mailing Address - State:MO
Mailing Address - Zip Code:63548-4105
Mailing Address - Country:US
Mailing Address - Phone:641-777-1225
Mailing Address - Fax:
Practice Address - Street 1:208 E FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:BLOOMFIELD
Practice Address - State:IA
Practice Address - Zip Code:52537-1685
Practice Address - Country:US
Practice Address - Phone:641-664-3100
Practice Address - Fax:641-664-2290
Is Sole Proprietor?:Yes
Enumeration Date:2005-10-27
Last Update Date:2021-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA17966183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist