Provider Demographics
NPI:1912376849
Name:ROE RX INC
Entity Type:Organization
Organization Name:ROE RX INC
Other - Org Name:WESTSIDE HEALTH MART
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER,PIC,AO
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:801-698-2497
Mailing Address - Street 1:1378 W 1800 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-2826
Mailing Address - Country:US
Mailing Address - Phone:801-782-3611
Mailing Address - Fax:801-737-9160
Practice Address - Street 1:1407 N 2000 W STE E
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:UT
Practice Address - Zip Code:84015-8563
Practice Address - Country:US
Practice Address - Phone:801-784-5495
Practice Address - Fax:801-784-5499
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-22
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0004X, 3336C0004X, 3336S0011X
UT953304417033336C0003X, 333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336S0011XSuppliersPharmacySpecialty Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2153048OtherPK
UT1912376849Medicaid