Provider Demographics
NPI:1306190681
Name:ROFF, KATIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:
Last Name:ROFF
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 1:1729 MARKET BLVD
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:MN
Mailing Address - Zip Code:55033-1254
Mailing Address - Country:US
Mailing Address - Phone:651-438-2135
Mailing Address - Fax:651-438-3945
Practice Address - Street 1:1729 MARKET BLVD
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:MN
Practice Address - Zip Code:55033-1254
Practice Address - Country:US
Practice Address - Phone:651-438-2135
Practice Address - Fax:651-438-3945
Is Sole Proprietor?:No
Enumeration Date:2012-11-07
Last Update Date:2012-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN119710183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist