Provider Demographics
NPI:1669756243
Name:ROE, WENDY KAYE (RPH)
Entity type:Individual
Prefix:MRS
First Name:WENDY
Middle Name:KAYE
Last Name:ROE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5143 ROMAINE SPRING DR
Mailing Address - Street 2:
Mailing Address - City:FENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63026-5842
Mailing Address - Country:US
Mailing Address - Phone:636-600-0068
Mailing Address - Fax:
Practice Address - Street 1:5143 ROMAINE SPRING DR
Practice Address - Street 2:
Practice Address - City:FENTON
Practice Address - State:MO
Practice Address - Zip Code:63026-5842
Practice Address - Country:US
Practice Address - Phone:636-600-0068
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004031563183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist