MEDICARE: ROXANNE LYNN WILLIAM RPH

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	4060	SD

General Provider Information

NPI Number	:	1609176437
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROXANNE LYNN WILLIAM RPH

Provider Business Mailing Address
First Line	:	2120 MOUNT RUSHMORE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4623
Country	:	US
Telephone Number	:	605-348-7552
Fax Number	:	605-355-4559

Provider Business Practice Location Address
First Line	:	2120 MOUNT RUSHMORE RD
Second Line	:
City	:	RAPID CITY
State	:	SD
Zip	:	57701-4623
Country	:	US
Telephone Number	:	605-348-7552
Fax Number	:	605-355-4559

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

Provider Enumeration Date	:	10/26/2010
Last Update Date	:	10/26/2010

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