Provider Demographics
NPI:1639460405
Name:ROOD, GERALD G
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:G
Last Name:ROOD
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:785 S COLUMBIA RIVER HWY
Mailing Address - Street 2:
Mailing Address - City:SAINT HELENS
Mailing Address - State:OR
Mailing Address - Zip Code:97051-2928
Mailing Address - Country:US
Mailing Address - Phone:503-397-6787
Mailing Address - Fax:503-366-0610
Practice Address - Street 1:785 S COLUMBIA RIVER HWY
Practice Address - Street 2:
Practice Address - City:SAINT HELENS
Practice Address - State:OR
Practice Address - Zip Code:97051-2928
Practice Address - Country:US
Practice Address - Phone:503-397-6787
Practice Address - Fax:503-366-0610
Is Sole Proprietor?:No
Enumeration Date:2011-04-27
Last Update Date:2011-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR5050183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist