Provider Demographics
NPI:1245372523
Name:ROE, HAL R (RPH)
Entity type:Individual
Prefix:
First Name:HAL
Middle Name:R
Last Name:ROE
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1378 W 1800 N
Mailing Address - Street 2:
Mailing Address - City:OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84404-2826
Mailing Address - Country:US
Mailing Address - Phone:801-698-2497
Mailing Address - Fax:
Practice Address - Street 1:5257 ADAMS AVE PKWY
Practice Address - Street 2:
Practice Address - City:OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-6748
Practice Address - Country:US
Practice Address - Phone:801-698-2497
Practice Address - Fax:801-737-9160
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-13
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT150945-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist