Provider Demographics
NPI:1013222041
Name:ROOS, GRETHA BERRIOS (PHARM D)
Entity Type:Individual
Prefix:
First Name:GRETHA
Middle Name:BERRIOS
Last Name:ROOS
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 1:717 VINTAGE DR
Mailing Address - Street 2:
Mailing Address - City:KENNER
Mailing Address - State:LA
Mailing Address - Zip Code:70065-1926
Mailing Address - Country:US
Mailing Address - Phone:504-712-7964
Mailing Address - Fax:
Practice Address - Street 1:909 DAVID DR
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70003-5134
Practice Address - Country:US
Practice Address - Phone:504-818-1170
Practice Address - Fax:504-818-1738
Is Sole Proprietor?:No
Enumeration Date:2010-08-14
Last Update Date:2010-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA17095183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist