Provider Demographics
NPI:1205810462
Name:ROTERT, RICHARD BERNARD JR (RPH)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:BERNARD
Last Name:ROTERT
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:703 40TH PL
Mailing Address - Street 2:
Mailing Address - City:EVERETT
Mailing Address - State:WA
Mailing Address - Zip Code:98201-4863
Mailing Address - Country:US
Mailing Address - Phone:425-258-3638
Mailing Address - Fax:
Practice Address - Street 1:1825 BROADWAY
Practice Address - Street 2:
Practice Address - City:EVERETT
Practice Address - State:WA
Practice Address - Zip Code:98201-2348
Practice Address - Country:US
Practice Address - Phone:425-303-2584
Practice Address - Fax:425-258-6252
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00018525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist