Provider Demographics
NPI:1326218785
Name:ROE, ROBERT EARL (BS PHARM, RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:EARL
Last Name:ROE
Suffix:
Gender:M
Credentials:BS PHARM, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3334 LOOP 306
Mailing Address - Street 2:
Mailing Address - City:SAN ANGELO
Mailing Address - State:TX
Mailing Address - Zip Code:76904-5941
Mailing Address - Country:US
Mailing Address - Phone:325-947-6605
Mailing Address - Fax:325-947-6607
Practice Address - Street 1:3334 LOOP 306
Practice Address - Street 2:
Practice Address - City:SAN ANGELO
Practice Address - State:TX
Practice Address - Zip Code:76904-5941
Practice Address - Country:US
Practice Address - Phone:325-947-6605
Practice Address - Fax:325-947-6607
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-01
Last Update Date:2008-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX22630183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist