Provider Demographics
NPI:1639510076
Name:ROELLE, ABIGAIL JOSETTE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ABIGAIL
Middle Name:JOSETTE
Last Name:ROELLE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ABIGAIL
Other - Middle Name:JOSETTE
Other - Last Name:MOYSEENKO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:7020 E REGINA ST
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85207
Mailing Address - Country:US
Mailing Address - Phone:330-671-0411
Mailing Address - Fax:
Practice Address - Street 1:805 S VAL VISTA DR
Practice Address - Street 2:
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296
Practice Address - Country:US
Practice Address - Phone:480-892-6039
Practice Address - Fax:480-892-1973
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-15
Last Update Date:2020-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03232989-2183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist