Provider Demographics
NPI:1477719680
Name:ROTH DRUG COMPANY
Entity Type:Organization
Organization Name:ROTH DRUG COMPANY
Other - Org Name:ROTH DRUG CO
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DAMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:832-533-2951
Mailing Address - Street 1:15948 S POST OAK RD
Mailing Address - Street 2:STE C
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77053-3645
Mailing Address - Country:US
Mailing Address - Phone:832-533-2951
Mailing Address - Fax:832-533-2022
Practice Address - Street 1:15948 S POST OAK RD
Practice Address - Street 2:STE C
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77053-3645
Practice Address - Country:US
Practice Address - Phone:832-533-2951
Practice Address - Fax:832-533-2022
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-07
Last Update Date:2009-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX260993336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
4549082OtherNCPDP PROVIDER IDENTIFICATION NUMBER