Healthcare Provider Details

I. General information

NPI: 1770666539
Provider Name (Legal Business Name): ROGER IRA GARRETT SR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WIESBADEN ARMY HEALTH CLINIC UNIT 29623
APO AE
09096
DE

IV. Provider business mailing address

LANDSTUHL REGIONAL MEDICAL CENTER CMR 402
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 490611705
  • Fax:
Mailing address:
  • Phone: 490611705
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00006291
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: