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General NPI Number Information
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NPI Number | 1861609364
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Entity Type | Individual
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Provider Name | DAVID L ROE PHARMACIST
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Gender | Male
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Dates
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Enumeration Date | 05/16/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | WELAKA PHARMACY 698 THIRD AVE
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City | WELAKA
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State | FL
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Zip | 32193
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Country | US
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Telephone | 386-467-9994
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Fax |
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Provider Business Mailing Address
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Address Line | 205 PORT COMFORT DR
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City | EAST PALATKA
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State | FL
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Zip | 32131-4327
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Country | US
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Telephone | 386-328-2961
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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 | 16476
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License Number State | FL
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