Provider Demographics
NPI:1255742144
Name:ROEHL, DANIEL (PHARM D)
Entity type:Individual
Prefix:DR
First Name:DANIEL
Middle Name:
Last Name:ROEHL
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11401 MARKETPLACE DR N
Mailing Address - Street 2:
Mailing Address - City:CHAMPLIN
Mailing Address - State:MN
Mailing Address - Zip Code:55316-3794
Mailing Address - Country:US
Mailing Address - Phone:763-427-6389
Mailing Address - Fax:
Practice Address - Street 1:11401 MARKETPLACE DR N
Practice Address - Street 2:
Practice Address - City:CHAMPLIN
Practice Address - State:MN
Practice Address - Zip Code:55316-3794
Practice Address - Country:US
Practice Address - Phone:763-427-6389
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-05-13
Last Update Date:2014-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN121436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist