Provider Demographics
NPI:1821697699
Name:ROPER, BRENT ALLEN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:ALLEN
Last Name:ROPER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:177 JUNIPER TRL
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:TX
Mailing Address - Zip Code:78621-5617
Mailing Address - Country:US
Mailing Address - Phone:737-200-9131
Mailing Address - Fax:
Practice Address - Street 1:177 JUNIPER TRL
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:TX
Practice Address - Zip Code:78621-5617
Practice Address - Country:US
Practice Address - Phone:737-200-9131
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-22
Last Update Date:2020-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33449183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist