Provider Demographics
NPI:1417289018
Name:ROES, GARY J (BS, RPH)
Entity Type:Individual
Prefix:MR
First Name:GARY
Middle Name:J
Last Name:ROES
Suffix:
Gender:M
Credentials:BS, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 MAXWELL ST
Mailing Address - Street 2:
Mailing Address - City:W HEMPSTEAD
Mailing Address - State:NY
Mailing Address - Zip Code:11552-1819
Mailing Address - Country:US
Mailing Address - Phone:516-351-3870
Mailing Address - Fax:516-683-8318
Practice Address - Street 1:1250 OLD COUNTRY RD
Practice Address - Street 2:
Practice Address - City:WESTBURY
Practice Address - State:NY
Practice Address - Zip Code:11590-5624
Practice Address - Country:US
Practice Address - Phone:516-351-3870
Practice Address - Fax:516-683-8318
Is Sole Proprietor?:No
Enumeration Date:2010-02-06
Last Update Date:2010-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY041933183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist