Provider Demographics
NPI:1871185553
Name:ROECKER, ANDREW M (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREW
Middle Name:M
Last Name:ROECKER
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 S MAIN ST UNIT 1
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OH
Mailing Address - Zip Code:45810-1599
Mailing Address - Country:US
Mailing Address - Phone:419-772-2283
Mailing Address - Fax:
Practice Address - Street 1:525 S MAIN ST UNIT 1
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OH
Practice Address - Zip Code:45810-1599
Practice Address - Country:US
Practice Address - Phone:419-772-2283
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-04
Last Update Date:2021-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03324254183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist