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NPI Code Detail

MEDICARE: MRS. JENNIFER ROEHM RPH

MEDICARE: MRS. JENNIFER ROEHM RPH
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist26021248AIN
2183500000XPharmacist013675KY

General Provider Information

NPI Number : 1164846531
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JENNIFER ROEHM RPH
Provider Business Mailing Address
First Line : 4222 CHARLESTOWN RD
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-9567
Country : US
Telephone Number : 812-542-3810
Fax Number : 812-542-3865
Provider Business Practice Location Address
First Line : 4222 CHARLESTOWN RD
Second Line :
City : NEW ALBANY
State : IN
Zip : 47150-9567
Country : US
Telephone Number : 812-542-3810
Fax Number : 812-542-3865
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/05/2014
Last Update Date : 02/05/2014

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