Healthcare Provider Details

I. General information

NPI: 1972500395
Provider Name (Legal Business Name): ALAN ROACH RPH, DPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1441 N BECKLEY AVE METHODIST HOSPITAL OF DALLAS
DALLAS TX
75203-1201
US

IV. Provider business mailing address

1700 YELLOWSTONE AVE
LEWISVILLE TX
75077-2466
US

V. Phone/Fax

Practice location:
  • Phone: 214-947-2400
  • Fax: 214-947-2501
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number27311
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: