Provider Demographics
NPI:1790374155
Name:ROA, DAVID JAFET
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:JAFET
Last Name:ROA
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 1:3663 WASHINGTON AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77007-6469
Mailing Address - Country:US
Mailing Address - Phone:713-426-1961
Mailing Address - Fax:866-613-0189
Practice Address - Street 1:3663 WASHINGTON AVE STE 100
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77007-6469
Practice Address - Country:US
Practice Address - Phone:713-426-1961
Practice Address - Fax:866-613-0189
Is Sole Proprietor?:No
Enumeration Date:2021-01-11
Last Update Date:2021-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician