Provider Demographics
NPI:1871506022
Name:ROE RX INC
Entity Type:Organization
Organization Name:ROE RX INC
Other - Org Name:DBA WANGSGARD PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HAL
Authorized Official - Middle Name:
Authorized Official - Last Name:ROE
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:801-399-4400
Mailing Address - Street 1:120 N WASHINGTON BLVD
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-3937
Mailing Address - Country:US
Mailing Address - Phone:801-399-4400
Mailing Address - Fax:801-399-1789
Practice Address - Street 1:120 N WASHINGTON BOULEVARD
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84404-3937
Practice Address - Country:US
Practice Address - Phone:801-399-4400
Practice Address - Fax:801-399-1789
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-15
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT5023506-1703332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Not Answered3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT=========035Medicaid
UT=========035Medicaid