Provider Demographics
NPI:1982941944
Name:GRABACH, ROGER (RPH)
Entity Type:Individual
Prefix:
First Name:ROGER
Middle Name:
Last Name:GRABACH
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 1:1255 US 1
Mailing Address - Street 2:
Mailing Address - City:VERO BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32960-5729
Mailing Address - Country:US
Mailing Address - Phone:772-778-4771
Mailing Address - Fax:772-778-6954
Practice Address - Street 1:1255 US 1
Practice Address - Street 2:
Practice Address - City:VERO BEACH
Practice Address - State:FL
Practice Address - Zip Code:32960-5729
Practice Address - Country:US
Practice Address - Phone:772-778-4771
Practice Address - Fax:772-778-6954
Is Sole Proprietor?:No
Enumeration Date:2013-01-10
Last Update Date:2013-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS17521183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist