Provider Demographics
NPI:1659922219
Name:ROE, DUSTIN THOMAS (PHARMD)
Entity Type:Individual
Prefix:
First Name:DUSTIN
Middle Name:THOMAS
Last Name:ROE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:116 ENDICOTT CT
Mailing Address - Street 2:
Mailing Address - City:MOORESVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28115-5225
Mailing Address - Country:US
Mailing Address - Phone:828-964-6918
Mailing Address - Fax:
Practice Address - Street 1:430 WESTERN AVE
Practice Address - Street 2:
Practice Address - City:STATESVILLE
Practice Address - State:NC
Practice Address - Zip Code:28677-5730
Practice Address - Country:US
Practice Address - Phone:704-873-7612
Practice Address - Fax:704-872-8037
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2023-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC29089183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist