Healthcare Provider Details

I. General information

NPI: 1205441193
Provider Name (Legal Business Name): ALEXIS ROE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/09/2020
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

505 N JACKSON ST
JACKSON MI
49201-1266
US

IV. Provider business mailing address

124 NORTHFIELD DR
JACKSON MI
49203-4831
US

V. Phone/Fax

Practice location:
  • Phone: 517-748-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302048652
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: