Healthcare Provider Details

I. General information

NPI: 1205810462
Provider Name (Legal Business Name): RICHARD BERNARD ROTERT JR. RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/01/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1825 BROADWAY
EVERETT WA
98201-2348
US

IV. Provider business mailing address

703 40TH PL
EVERETT WA
98201-4863
US

V. Phone/Fax

Practice location:
  • Phone: 425-303-2584
  • Fax: 425-258-6252
Mailing address:
  • Phone: 425-258-3638
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberPH00018525
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: