Provider Demographics
NPI:1609176437
Name:WILLIAM, ROXANNE LYNN (RPH)
Entity Type:Individual
Prefix:
First Name:ROXANNE
Middle Name:LYNN
Last Name:WILLIAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2120 MOUNT RUSHMORE RD
Mailing Address - Street 2:
Mailing Address - City:RAPID CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57701-4623
Mailing Address - Country:US
Mailing Address - Phone:605-348-7552
Mailing Address - Fax:605-355-4559
Practice Address - Street 1:2120 MOUNT RUSHMORE RD
Practice Address - Street 2:
Practice Address - City:RAPID CITY
Practice Address - State:SD
Practice Address - Zip Code:57701-4623
Practice Address - Country:US
Practice Address - Phone:605-348-7552
Practice Address - Fax:605-355-4559
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD4060183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist