Provider Demographics
NPI:1134725161
Name:RODDAM, TROY (PHARMD)
Entity type:Individual
Prefix:
First Name:TROY
Middle Name:
Last Name:RODDAM
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 1:10741 W EL CORTEZ PL APT 2168
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85383-9627
Mailing Address - Country:US
Mailing Address - Phone:602-320-8181
Mailing Address - Fax:
Practice Address - Street 1:10741 W EL CORTEZ PL APT 2168
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85383-9627
Practice Address - Country:US
Practice Address - Phone:602-320-8181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-06
Last Update Date:2020-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS022910183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist