MEDICARE: MRS. RACHELLE A ROA 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
1	183500000X	Pharmacist	16582	CO

General Provider Information

NPI Number	:	1194783746
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. RACHELLE A ROA PHARM.D.

Provider Business Mailing Address
First Line	:	4091 S LISBON WAY
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-6037
Country	:	US
Telephone Number	:	303-503-6619
Fax Number	:

Provider Business Practice Location Address
First Line	:	4091 S LISBON WAY
Second Line	:
City	:	AURORA
State	:	CO
Zip	:	80013-6037
Country	:	US
Telephone Number	:	303-503-6619
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/03/2006
Last Update Date	:	01/23/2015

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