MEDICARE: ROSHELLE GOERTZ PHARMD

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	5220	SD

General Provider Information

NPI Number	:	1922481308
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROSHELLE GOERTZ PHARMD

Provider Business Mailing Address
First Line	:	2150 DAKOTA AVE S
Second Line	:
City	:	HURON
State	:	SD
Zip	:	57350-4311
Country	:	US
Telephone Number	:	605-352-1641
Fax Number	:	605-352-9663

Provider Business Practice Location Address
First Line	:	2150 DAKOTA AVE S
Second Line	:
City	:	HURON
State	:	SD
Zip	:	57350-4311
Country	:	US
Telephone Number	:	605-352-1641
Fax Number	:	605-352-9663

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

Provider Enumeration Date	:	07/03/2015
Last Update Date	:	07/03/2015

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Directions to “ ROSHELLE GOERTZ PHARMD” Practice Location

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