Provider Demographics
NPI:1598107823
Name:ROE, ELENA MARIE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ELENA
Middle Name:MARIE
Last Name:ROE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:750 LOST NATION TRL
Mailing Address - Street 2:
Mailing Address - City:TRAVERSE CITY
Mailing Address - State:MI
Mailing Address - Zip Code:49686-8185
Mailing Address - Country:US
Mailing Address - Phone:231-632-8282
Mailing Address - Fax:
Practice Address - Street 1:975 W SOUTH AIRPORT RD
Practice Address - Street 2:
Practice Address - City:TRAVERSE CITY
Practice Address - State:MI
Practice Address - Zip Code:49686-4846
Practice Address - Country:US
Practice Address - Phone:231-946-5840
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-29
Last Update Date:2013-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302039311183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist