Provider Demographics
NPI:1821009325
Name:ROE & ROE INC
Entity Type:Organization
Organization Name:ROE & ROE INC
Other - Org Name:HOMEDALE DRUG
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VP
Authorized Official - Prefix:
Authorized Official - First Name:EDITH
Authorized Official - Middle Name:
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:208-337-3898
Mailing Address - Street 1:5 N MAIN
Mailing Address - Street 2:
Mailing Address - City:HOMEDALE
Mailing Address - State:ID
Mailing Address - Zip Code:83628-0037
Mailing Address - Country:US
Mailing Address - Phone:208-337-3898
Mailing Address - Fax:208-337-4652
Practice Address - Street 1:5 N MAIN
Practice Address - Street 2:
Practice Address - City:HOMEDALE
Practice Address - State:ID
Practice Address - Zip Code:83628
Practice Address - Country:US
Practice Address - Phone:208-337-3898
Practice Address - Fax:208-337-4652
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 3336L0003X, 3336M0002X
ID1418CP3336C0003X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336M0002XSuppliersPharmacyMail Order Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR297021Medicaid
1306770OtherNCPDP PROVIDER IDENTIFICATION NUMBER
ID805397800Medicaid
ID805397800Medicaid