Provider Demographics
NPI:1013353366
Name:ROACH, LAUREN REBECCA (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:LAUREN
Middle Name:REBECCA
Last Name:ROACH
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:LAUREN
Other - Middle Name:REBECCA
Other - Last Name:ST.JEAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARM D
Mailing Address - Street 1:804 FALLS BLVD S
Mailing Address - Street 2:
Mailing Address - City:WYNNE
Mailing Address - State:AR
Mailing Address - Zip Code:72396-3505
Mailing Address - Country:US
Mailing Address - Phone:870-238-7085
Mailing Address - Fax:
Practice Address - Street 1:804 FALLS BLVD S
Practice Address - Street 2:
Practice Address - City:WYNNE
Practice Address - State:AR
Practice Address - Zip Code:72396-3505
Practice Address - Country:US
Practice Address - Phone:870-238-7085
Practice Address - Fax:870-238-8937
Is Sole Proprietor?:No
Enumeration Date:2013-05-14
Last Update Date:2014-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARPD11305183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist