Provider Demographics
NPI:1336676386
Name:ROUX, WILLIAM JR (RPH)
Entity Type:Individual
Prefix:
First Name:WILLIAM
Middle Name:
Last Name:ROUX
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:291 S MAIN ST APT 2
Mailing Address - Street 2:
Mailing Address - City:TORRINGTON
Mailing Address - State:CT
Mailing Address - Zip Code:06790-6768
Mailing Address - Country:US
Mailing Address - Phone:860-839-1691
Mailing Address - Fax:
Practice Address - Street 1:58 HIGH ST
Practice Address - Street 2:
Practice Address - City:TORRINGTON
Practice Address - State:CT
Practice Address - Zip Code:06790-5106
Practice Address - Country:US
Practice Address - Phone:860-496-2107
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-20
Last Update Date:2017-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT9012183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist