Provider Demographics
NPI:1699841486
Name:POOLE, ROXANNE G (RD)
Entity Type:Individual
Prefix:MS
First Name:ROXANNE
Middle Name:G
Last Name:POOLE
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:317 SHORE RD
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:SC
Mailing Address - Zip Code:29054-9162
Mailing Address - Country:US
Mailing Address - Phone:803-892-3007
Mailing Address - Fax:803-892-0514
Practice Address - Street 1:1175 COOK RD
Practice Address - Street 2:SUITE 115
Practice Address - City:ORANGEBURG
Practice Address - State:SC
Practice Address - Zip Code:29118-8201
Practice Address - Country:US
Practice Address - Phone:803-531-2677
Practice Address - Fax:803-531-8561
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-26
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered