Provider Demographics
NPI:1598788663
Name:WURTZBACHER, ROGER O (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROGER
Middle Name:O
Last Name:WURTZBACHER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2419 FAR HILLS AVE
Mailing Address - Street 2:
Mailing Address - City:DAYTON
Mailing Address - State:OH
Mailing Address - Zip Code:45419-1502
Mailing Address - Country:US
Mailing Address - Phone:937-293-3172
Mailing Address - Fax:937-293-8539
Practice Address - Street 1:2419 FAR HILLS AVE
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:OH
Practice Address - Zip Code:45419-1502
Practice Address - Country:US
Practice Address - Phone:937-293-3172
Practice Address - Fax:937-293-8539
Is Sole Proprietor?:No
Enumeration Date:2006-07-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-06340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist