Healthcare Provider Details

I. General information

NPI: 1881119469
Provider Name (Legal Business Name): ROE RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5257 ADAMS AVE PKWY
WASHINGTON TERRACE UT
84405-6748
US

IV. Provider business mailing address

1378 W 1800 N
OGDEN UT
84404-2826
US

V. Phone/Fax

Practice location:
  • Phone: 801-689-3420
  • Fax: 385-405-2191
Mailing address:
  • Phone: 801-698-2497
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number10394585-1703
License Number StateUT
# 2
Primary TaxonomyN
Taxonomy Code3336H0001X
TaxonomyHome Infusion Therapy Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number10394585-1703
License Number StateUT

VII. Legacy identifiers

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

VIII. Authorized Official

Name: JOSH WILDE
Title or Position: PIC
Credential:
Phone: 801-689-3420