Provider Demographics
NPI:1821308040
Name:KALBA, ROXANNA (RPH,MSA)
Entity Type:Individual
Prefix:
First Name:ROXANNA
Middle Name:
Last Name:KALBA
Suffix:
Gender:F
Credentials:RPH,MSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29101 JOHN R RD
Mailing Address - Street 2:
Mailing Address - City:MADISON HEIGHTS
Mailing Address - State:MI
Mailing Address - Zip Code:48071-5417
Mailing Address - Country:US
Mailing Address - Phone:248-546-8076
Mailing Address - Fax:
Practice Address - Street 1:29101 JOHN R RD
Practice Address - Street 2:
Practice Address - City:MADISON HEIGHTS
Practice Address - State:MI
Practice Address - Zip Code:48071-5417
Practice Address - Country:US
Practice Address - Phone:248-546-8076
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-21
Last Update Date:2010-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024767183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5302024767OtherSTATE OF MICHIGAN LICENSE