Provider Demographics
NPI:1396252870
Name:ROPER, MARK A (PHARMD, MBA, MS)
Entity type:Individual
Prefix:DR
First Name:MARK
Middle Name:A
Last Name:ROPER
Suffix:
Gender:M
Credentials:PHARMD, MBA, MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18 LAWTON CIR
Mailing Address - Street 2:
Mailing Address - City:LYNCHBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24501-7755
Mailing Address - Country:US
Mailing Address - Phone:954-275-1282
Mailing Address - Fax:
Practice Address - Street 1:1126 E LYNCHBURG SALEM TPKE
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:VA
Practice Address - Zip Code:24523-3446
Practice Address - Country:US
Practice Address - Phone:540-586-6012
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-05
Last Update Date:2018-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL43249183500000X
UT6323074183500000X
VA0202207652183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist