Provider Demographics
NPI:1942903257
Name:ROOSEVELT PHARMACY INC.
Entity Type:Organization
Organization Name:ROOSEVELT PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACY MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AESHA
Authorized Official - Middle Name:
Authorized Official - Last Name:VORA
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMACIST
Authorized Official - Phone:980-505-5383
Mailing Address - Street 1:1606 E ROOSEVELT BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:NC
Mailing Address - Zip Code:28112-4049
Mailing Address - Country:US
Mailing Address - Phone:704-774-1313
Mailing Address - Fax:704-774-1315
Practice Address - Street 1:1606 E ROOSEVELT BLVD STE 103
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:NC
Practice Address - Zip Code:28112-4049
Practice Address - Country:US
Practice Address - Phone:704-774-1313
Practice Address - Fax:704-774-1315
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-03-24
Last Update Date:2023-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy