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General NPI Number Information
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NPI Number | 1407442098
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Entity Type | Individual
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Provider Name | MELISSA ANN ROOSE RAASCH RPH.
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Gender | Female
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Dates
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Enumeration Date | 12/17/2020
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Last Update Date | 12/17/2020
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Provider Practice Location Address
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Address Line | 1831 LAKE AVE
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City | STORM LAKE
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State | IA
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Zip | 50588-7606
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Country | US
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Telephone | 712-732-7960
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 290TH ST
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City | ODEBOLT
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State | IA
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Zip | 51458-7475
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Country | US
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Telephone | 712-210-0532
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 19057
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License Number State | IA
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