Provider Demographics
NPI:1093328833
Name:ROACH, STEVEN PAUL (PHARMD)
Entity Type:Individual
Prefix:
First Name:STEVEN
Middle Name:PAUL
Last Name:ROACH
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 1:131 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-3412
Mailing Address - Country:US
Mailing Address - Phone:706-896-2255
Mailing Address - Fax:
Practice Address - Street 1:131 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HIAWASSEE
Practice Address - State:GA
Practice Address - Zip Code:30546-3412
Practice Address - Country:US
Practice Address - Phone:706-896-2255
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-30
Last Update Date:2020-08-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH031423183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH031423OtherGEORGIA STATE BOARD OF PHARMACY