Provider Demographics
NPI:1194723254
Name:HOMAR, ROXANNE (RPH)
Entity type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:
Last Name:HOMAR
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 1:7009 VALLEY VIEW PL
Mailing Address - Street 2:
Mailing Address - City:CHEYENNE
Mailing Address - State:WY
Mailing Address - Zip Code:82009-2503
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2300 CAPITOL AVE
Practice Address - Street 2:117 HATHAWAY BLDG
Practice Address - City:CHEYENNE
Practice Address - State:WY
Practice Address - Zip Code:82002-0001
Practice Address - Country:US
Practice Address - Phone:307-777-6032
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY2701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist