Provider Demographics
NPI:1538461009
Name:FOUTZ, ROGER WRIGHT JR (RPH)
Entity type:Individual
Prefix:MR
First Name:ROGER
Middle Name:WRIGHT
Last Name:FOUTZ
Suffix:JR
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 1:536 HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:ROANOKE
Mailing Address - State:VA
Mailing Address - Zip Code:24019-8580
Mailing Address - Country:US
Mailing Address - Phone:540-966-3291
Mailing Address - Fax:
Practice Address - Street 1:7223 WILLIAMSON RD
Practice Address - Street 2:
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24019-4234
Practice Address - Country:US
Practice Address - Phone:540-561-3938
Practice Address - Fax:540-561-3939
Is Sole Proprietor?:Yes
Enumeration Date:2010-12-03
Last Update Date:2010-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202004146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist