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NPI Code Detail

MEDICARE: MR. NORMAN MICHAEL ROETS PHARMACIST

MEDICARE: MR. NORMAN MICHAEL ROETS PHARMACIST
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
1183500000XPharmacist7464WI

General Provider Information

NPI Number : 1326318452
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. NORMAN MICHAEL ROETS PHARMACIST
Provider Business Mailing Address
First Line : 3109 S KINNICKINNIC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-2935
Country : US
Telephone Number : 414-482-3515
Fax Number : 414-482-9680
Provider Business Practice Location Address
First Line : 3109 S KINNICKINNIC AVE
Second Line :
City : MILWAUKEE
State : WI
Zip : 53207-2935
Country : US
Telephone Number : 414-482-3515
Fax Number : 414-482-9680
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/05/2012
Last Update Date : 01/05/2012

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