Provider Demographics
NPI:1730513862
Name:ROATH, ERIC D (PHARMD)
Entity type:Individual
Prefix:DR
First Name:ERIC
Middle Name:D
Last Name:ROATH
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5631 ELLENDALE DR
Mailing Address - Street 2:
Mailing Address - City:LANSING
Mailing Address - State:MI
Mailing Address - Zip Code:48911-5029
Mailing Address - Country:US
Mailing Address - Phone:906-282-8930
Mailing Address - Fax:
Practice Address - Street 1:408 KALAMAZOO PLZ
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48933-1901
Practice Address - Country:US
Practice Address - Phone:517-377-0224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-08-26
Last Update Date:2017-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302038746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist