Provider Demographics
NPI:1417232166
Name:VAN ROEKEL, LOUIS J (RBG PHA (RPH))
Entity Type:Individual
Prefix:MR
First Name:LOUIS
Middle Name:J
Last Name:VAN ROEKEL
Suffix:
Gender:M
Credentials:RBG PHA (RPH)
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E SIOUX
Mailing Address - Street 2:
Mailing Address - City:PIERRE
Mailing Address - State:SD
Mailing Address - Zip Code:57501
Mailing Address - Country:US
Mailing Address - Phone:605-224-4962
Mailing Address - Fax:605-945-0062
Practice Address - Street 1:100 E SIOUX
Practice Address - Street 2:
Practice Address - City:PIERRE
Practice Address - State:SD
Practice Address - Zip Code:57501
Practice Address - Country:US
Practice Address - Phone:605-224-4962
Practice Address - Fax:605-945-0062
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-13
Last Update Date:2011-10-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD100.1920183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist