Provider Demographics
NPI:1770753709
Name:ROEHRS, MARVIN ANDREW (PHARMACIS)
Entity type:Individual
Prefix:
First Name:MARVIN
Middle Name:ANDREW
Last Name:ROEHRS
Suffix:
Gender:M
Credentials:PHARMACIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52 E ARROW ST
Mailing Address - Street 2:
Mailing Address - City:MARSHALL
Mailing Address - State:MO
Mailing Address - Zip Code:65340-2101
Mailing Address - Country:US
Mailing Address - Phone:660-886-5534
Mailing Address - Fax:660-886-2121
Practice Address - Street 1:52 E ARROW ST
Practice Address - Street 2:
Practice Address - City:MARSHALL
Practice Address - State:MO
Practice Address - Zip Code:65340-2101
Practice Address - Country:US
Practice Address - Phone:660-886-5534
Practice Address - Fax:660-886-2121
Is Sole Proprietor?:No
Enumeration Date:2008-03-05
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO040593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist