Provider Demographics
NPI:1376261966
Name:ROSKOPF, DERRICK ANDREW (PHARMD)
Entity Type:Individual
Prefix:MR
First Name:DERRICK
Middle Name:ANDREW
Last Name:ROSKOPF
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 1:9075 W SURA LN UNIT 302
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-3550
Mailing Address - Country:US
Mailing Address - Phone:414-322-3378
Mailing Address - Fax:
Practice Address - Street 1:230 MADISON ST
Practice Address - Street 2:
Practice Address - City:WAUKESHA
Practice Address - State:WI
Practice Address - Zip Code:53188-5148
Practice Address - Country:US
Practice Address - Phone:262-542-9935
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-08-18
Last Update Date:2022-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI21421-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist