Individual
ERNEST PAUL ROALES
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
208 N MAIN ST, BRIDGEPORT, IL 62417-1522
(618) 945-3701
(618) 945-9382
Mailing address
PO BOX 75, BRIDGEPORT, IL 62417-0075
(616) 945-3701
(618) 945-9382
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
051032960
IL
Other
Enumeration date
02/01/2018
Last updated
02/01/2018
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