Provider Demographics
NPI:1881119469
Name:ROE RX INC
Entity type:Organization
Organization Name:ROE RX INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PIC
Authorized Official - Prefix:
Authorized Official - First Name:JOSH
Authorized Official - Middle Name:
Authorized Official - Last Name:WILDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-689-3420
Mailing Address - Street 1:1378 W 1800 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-2826
Mailing Address - Country:US
Mailing Address - Phone:801-698-2497
Mailing Address - Fax:
Practice Address - Street 1:5257 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:WASHINGTON TERRACE
Practice Address - State:UT
Practice Address - Zip Code:84405-6748
Practice Address - Country:US
Practice Address - Phone:801-689-3420
Practice Address - Fax:385-405-2191
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROE RX INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-04
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT10394585-17033336C0004X, 3336C0003X
3336H0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
No3336H0001XSuppliersPharmacyHome Infusion Therapy Pharmacy