Provider Demographics
NPI:1003345935
Name:ROACH, MEREDITH RHODES (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:RHODES
Last Name:ROACH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:168 GASTON AVE
Mailing Address - Street 2:
Mailing Address - City:FAIRHOPE
Mailing Address - State:AL
Mailing Address - Zip Code:36532-1551
Mailing Address - Country:US
Mailing Address - Phone:601-906-1186
Mailing Address - Fax:
Practice Address - Street 1:21141 STATE HIGHWAY 59
Practice Address - Street 2:
Practice Address - City:ROBERTSDALE
Practice Address - State:AL
Practice Address - Zip Code:36567-6740
Practice Address - Country:US
Practice Address - Phone:251-947-4412
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-05
Last Update Date:2017-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL161213336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy