Provider Demographics
NPI:1073901914
Name:ROH, HAE
Entity Type:Individual
Prefix:
First Name:HAE
Middle Name:
Last Name:ROH
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5818 BELLFLOWER BLVD
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CA
Mailing Address - Zip Code:90713-1058
Mailing Address - Country:US
Mailing Address - Phone:562-866-5795
Mailing Address - Fax:562-866-0257
Practice Address - Street 1:5818 BELLFLOWER BLVD
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CA
Practice Address - Zip Code:90713-1058
Practice Address - Country:US
Practice Address - Phone:562-866-5795
Practice Address - Fax:562-866-0257
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-30
Last Update Date:2017-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA401581835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy