Provider Demographics
NPI:1164473161
Name:ROSWELL, MEREDITH C (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MEREDITH
Middle Name:C
Last Name:ROSWELL
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3417 TEXAS TRL
Mailing Address - Street 2:
Mailing Address - City:HURST
Mailing Address - State:TX
Mailing Address - Zip Code:76054-6003
Mailing Address - Country:US
Mailing Address - Phone:817-428-9495
Mailing Address - Fax:
Practice Address - Street 1:8000 DENTON HWY
Practice Address - Street 2:
Practice Address - City:WATAUGA
Practice Address - State:TX
Practice Address - Zip Code:76148-2464
Practice Address - Country:US
Practice Address - Phone:817-427-1099
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX41769183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist