Provider Demographics
NPI:1467150607
Name:DELISLE, ROXANNE MICHELLE (CPHT, LPHT)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:MICHELLE
Last Name:DELISLE
Suffix:
Gender:F
Credentials:CPHT, LPHT
Other - Prefix:
Other - First Name:ROXANNE
Other - Middle Name:MICHELLE
Other - Last Name:KREINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPHT, LPHT
Mailing Address - Street 1:134 SUMMIT DR
Mailing Address - Street 2:
Mailing Address - City:LAPEER
Mailing Address - State:MI
Mailing Address - Zip Code:48446-1400
Mailing Address - Country:US
Mailing Address - Phone:810-610-9784
Mailing Address - Fax:
Practice Address - Street 1:337 N STATE RD
Practice Address - Street 2:
Practice Address - City:OTISVILLE
Practice Address - State:MI
Practice Address - Zip Code:48463-9486
Practice Address - Country:US
Practice Address - Phone:810-631-4551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-17
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5303032567183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1435854OtherNABP
MI5303032567OtherLARA
MI30111877OtherPTCB