MEDICARE: MR. WILLIAM J 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
1	183500000X	Pharmacist	4018	SD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1467438960
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. WILLIAM J ROTH

Provider Business Mailing Address
First Line	:	PO BOX 316
Second Line	:
City	:	SALEM
State	:	SD
Zip	:	57058-0316
Country	:	US
Telephone Number	:	605-425-2827
Fax Number	:	605-425-2052

Provider Business Practice Location Address
First Line	:	300 N MAIN ST
Second Line	:
City	:	SALEM
State	:	SD
Zip	:	57058
Country	:	US
Telephone Number	:	605-425-2827
Fax Number	:	605-425-2052

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

Provider Enumeration Date	:	12/16/2005
Last Update Date	:	07/08/2007

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Directions to “ MR. WILLIAM J ROTH ” Practice Location

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