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NPI Code Detail

MEDICARE: DR. LAUREN REBECCA ROACH PHARM D

MEDICARE: DR. LAUREN REBECCA ROACH PHARM D
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacistPD11305AR

General Provider Information

NPI Number : 1013353366
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. LAUREN REBECCA ROACH PHARM D
Provider Business Mailing Address
First Line : 804 FALLS BLVD S
Second Line :
City : WYNNE
State : AR
Zip : 72396-3505
Country : US
Telephone Number : 870-238-7085
Fax Number :
Provider Business Practice Location Address
First Line : 804 FALLS BLVD S
Second Line :
City : WYNNE
State : AR
Zip : 72396-3505
Country : US
Telephone Number : 870-238-7085
Fax Number : 870-238-8937
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/14/2013
Last Update Date : 06/25/2014

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Directions to “ DR. LAUREN REBECCA ROACH PHARM D” Practice Location

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