Healthcare Provider Details

I. General information

NPI: 1386966653
Provider Name (Legal Business Name): JEFFREY EUGENE ROTH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/26/2010
Last Update Date: 02/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4041 WASHINGTON RD
MC MURRAY PA
15317-2520
US

IV. Provider business mailing address

69 CLIFFORD DR
PITTSBURGH PA
15220-2712
US

V. Phone/Fax

Practice location:
  • Phone: 724-942-4927
  • Fax:
Mailing address:
  • Phone: 412-937-9174
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP031315L
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: