Provider Demographics
NPI:1154356681
Name:ROE, STEVEN R (R PH)
Entity type:Individual
Prefix:
First Name:STEVEN
Middle Name:R
Last Name:ROE
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1304 N WEST ST
Mailing Address - Street 2:
Mailing Address - City:MOUNT AYR
Mailing Address - State:IA
Mailing Address - Zip Code:50854-1057
Mailing Address - Country:US
Mailing Address - Phone:641-464-2362
Mailing Address - Fax:
Practice Address - Street 1:211 SHELLWAY DR
Practice Address - Street 2:
Practice Address - City:MOUNT AYR
Practice Address - State:IA
Practice Address - Zip Code:50854-1233
Practice Address - Country:US
Practice Address - Phone:641-464-4413
Practice Address - Fax:641-464-4453
Is Sole Proprietor?:No
Enumeration Date:2006-07-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA14586183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist