Provider Demographics
NPI:1194761585
Name:ROOTS PHARMACEUTICALS INC
Entity type:Organization
Organization Name:ROOTS PHARMACEUTICALS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:KYLE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROOTSAERT
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD RPH
Authorized Official - Phone:559-760-2934
Mailing Address - Street 1:12 W 100 N
Mailing Address - Street 2:STE 201B
Mailing Address - City:AMERICAN FORK
Mailing Address - State:UT
Mailing Address - Zip Code:84003-1611
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:12 W 100 N
Practice Address - Street 2:STE 201B
Practice Address - City:AMERICAN FORK
Practice Address - State:UT
Practice Address - Zip Code:84003-1611
Practice Address - Country:US
Practice Address - Phone:559-760-2934
Practice Address - Fax:559-756-7600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-22
Last Update Date:2008-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT605317817033336M0002X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4610451OtherOTHER ID NUMBER-COMMERCIAL NUMBER
4610451OtherOTHER ID NUMBER