Provider Demographics
NPI:1528451580
Name:ROPPEL, ROBERT DALE
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:DALE
Last Name:ROPPEL
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:38404 190TH AVE SE
Mailing Address - Street 2:
Mailing Address - City:ERSKINE
Mailing Address - State:MN
Mailing Address - Zip Code:56535-9414
Mailing Address - Country:US
Mailing Address - Phone:218-289-2152
Mailing Address - Fax:
Practice Address - Street 1:206 N MAIN ST
Practice Address - Street 2:
Practice Address - City:CROOKSTON
Practice Address - State:MN
Practice Address - Zip Code:56716-1743
Practice Address - Country:US
Practice Address - Phone:218-281-2541
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-03-13
Last Update Date:2015-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN113505183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist