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NPI Code Detail

MEDICARE: MRS. JEANNE MARIE ROTH

MEDICARE: MRS. JEANNE MARIE ROTH
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
1183500000XPharmacist16653NV

General Provider Information

NPI Number : 1053683144
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. JEANNE MARIE ROTH
Provider Business Mailing Address
First Line : 8410 FARM RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89131-8158
Country : US
Telephone Number : 702-658-6669
Fax Number : 702-658-7987
Provider Business Practice Location Address
First Line : 8410 FARM RD
Second Line :
City : LAS VEGAS
State : NV
Zip : 89131-8158
Country : US
Telephone Number : 702-658-6669
Fax Number : 702-658-7987
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/03/2012
Last Update Date : 02/03/2012

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Directions to “ MRS. JEANNE MARIE ROTH ” Practice Location

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