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General NPI Number Information
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NPI Number | 1457476715
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Entity Type | Individual
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Provider Name | MINA S ROUPHIEL
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Gender | Male
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Dates
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Enumeration Date | 03/19/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 3700 N DIXIE DR
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City | DAYTON
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State | OH
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Zip | 45414-5235
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Country | US
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Telephone | 937-275-7032
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Fax |
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Provider Business Mailing Address
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Address Line | 3607 KING EDWARD WAY
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City | BEAVERCREEK
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State | OH
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Zip | 45431-3796
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Country | US
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Telephone | 610-733-2852
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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 | 03-1-27632
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License Number State | OH
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