Provider Demographics
NPI:1407442098
Name:ROOSE RAASCH, MELISSA ANN (RPH)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:ANN
Last Name:ROOSE RAASCH
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 1:1817 290TH ST
Mailing Address - Street 2:
Mailing Address - City:ODEBOLT
Mailing Address - State:IA
Mailing Address - Zip Code:51458-7475
Mailing Address - Country:US
Mailing Address - Phone:712-210-0532
Mailing Address - Fax:
Practice Address - Street 1:1831 LAKE AVE
Practice Address - Street 2:
Practice Address - City:STORM LAKE
Practice Address - State:IA
Practice Address - Zip Code:50588-7606
Practice Address - Country:US
Practice Address - Phone:712-732-7960
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-17
Last Update Date:2020-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA19057183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist