Provider Demographics
NPI:1194712984
Name:VANROEKEL, TAMARA (RPH)
Entity type:Individual
Prefix:MRS
First Name:TAMARA
Middle Name:
Last Name:VANROEKEL
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:PO BOX 104
Mailing Address - Street 2:
Mailing Address - City:CORSICA
Mailing Address - State:SD
Mailing Address - Zip Code:57328-0104
Mailing Address - Country:US
Mailing Address - Phone:605-946-5722
Mailing Address - Fax:
Practice Address - Street 1:230 E. MAIN ST
Practice Address - Street 2:
Practice Address - City:CORSICA
Practice Address - State:SD
Practice Address - Zip Code:57328
Practice Address - Country:US
Practice Address - Phone:605-946-5549
Practice Address - Fax:605-946-5987
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4469183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
SD8502482Medicaid
SD8502482Medicaid