Provider Demographics
NPI:1043413933
Name:ROSHEIM, ELLIOT PAUL (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELLIOT
Middle Name:PAUL
Last Name:ROSHEIM
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1180 PIERCE TER NE
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA HEIGHTS
Mailing Address - State:MN
Mailing Address - Zip Code:55421-1841
Mailing Address - Country:US
Mailing Address - Phone:612-801-5957
Mailing Address - Fax:
Practice Address - Street 1:2750 ARTHUR ST
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:MN
Practice Address - Zip Code:55113-1303
Practice Address - Country:US
Practice Address - Phone:877-360-9272
Practice Address - Fax:651-635-9174
Is Sole Proprietor?:No
Enumeration Date:2007-06-07
Last Update Date:2008-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN116673183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist