Provider Demographics
NPI:1992282198
Name:ROTH, HARVEY L (RPH)
Entity type:Individual
Prefix:MR
First Name:HARVEY
Middle Name:L
Last Name:ROTH
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 LAKEWORTH CIR
Mailing Address - Street 2:
Mailing Address - City:LAKE MARY
Mailing Address - State:FL
Mailing Address - Zip Code:32746-5351
Mailing Address - Country:US
Mailing Address - Phone:407-754-4196
Mailing Address - Fax:407-332-9704
Practice Address - Street 1:252 W SR 434
Practice Address - Street 2:
Practice Address - City:LONGWOOD
Practice Address - State:FL
Practice Address - Zip Code:32750-5114
Practice Address - Country:US
Practice Address - Phone:407-332-9753
Practice Address - Fax:407-332-9704
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-20
Last Update Date:2018-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS20712183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist