Provider Demographics
NPI:1114227410
Name:ROETHER, ANTHONY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANTHONY
Middle Name:
Last Name:ROETHER
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 1:1939 FRONTAGE RD STE B
Mailing Address - Street 2:
Mailing Address - City:SIERRA VISTA
Mailing Address - State:AZ
Mailing Address - Zip Code:85635-4638
Mailing Address - Country:US
Mailing Address - Phone:520-459-0705
Mailing Address - Fax:
Practice Address - Street 1:1939 FRONTAGE RD STE B
Practice Address - Street 2:
Practice Address - City:SIERRA VISTA
Practice Address - State:AZ
Practice Address - Zip Code:85635-4638
Practice Address - Country:US
Practice Address - Phone:520-459-0705
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-11-02
Last Update Date:2012-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS016217183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist