Individual
KRISTY JO ROTH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PHARMD
Contact information
Practice address
0975N 00 EW, LAGRANGE, IN 46761
(260) 463-2583
Mailing address
2985 W 050 N, LAGRANGE, IN 46761-9460
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
26027037A
IN
Other
Enumeration date
08/12/2019
Last updated
08/12/2019
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