Provider Demographics
NPI:1457358129
Name:ROESENER, GERALD H (RPH)
Entity Type:Individual
Prefix:MR
First Name:GERALD
Middle Name:H
Last Name:ROESENER
Suffix:
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 1:2202 WOODSWAY DR
Mailing Address - Street 2:
Mailing Address - City:GREENWOOD
Mailing Address - State:IN
Mailing Address - Zip Code:46143-9564
Mailing Address - Country:US
Mailing Address - Phone:317-535-6165
Mailing Address - Fax:317-535-6166
Practice Address - Street 1:2202 WOODSWAY DR
Practice Address - Street 2:
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-9564
Practice Address - Country:US
Practice Address - Phone:317-535-6165
Practice Address - Fax:317-535-6166
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-07-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26012292A1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy