Provider Demographics
NPI:1336449552
Name:ROEBER, MICHAEL CLARK (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:CLARK
Last Name:ROEBER
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 1:1076 CY AVE
Mailing Address - Street 2:
Mailing Address - City:CASPER
Mailing Address - State:WY
Mailing Address - Zip Code:82604-3561
Mailing Address - Country:US
Mailing Address - Phone:307-266-0156
Mailing Address - Fax:307-266-4982
Practice Address - Street 1:1076 CY AVE
Practice Address - Street 2:
Practice Address - City:CASPER
Practice Address - State:WY
Practice Address - Zip Code:82604-3561
Practice Address - Country:US
Practice Address - Phone:307-266-0156
Practice Address - Fax:307-266-4982
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-22
Last Update Date:2010-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY3047183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist