Individual
BERNADEANE B ROTH
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
PHARM D
Contact information
Practice address
1333 W 5TH ST, STE. 107, SHERIDAN, WY 82801
(307) 673-3188
Mailing address
133 CANVASBACK RD, SHERIDAN, WY 82801-9040
(307) 672-5341
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
2959
WY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2959
WYOMING PHARMACY LICENSE
WY
Enumeration date
03/16/2006
Last updated
07/08/2007
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