Individual
STANLEY RAYMOND ROTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
RPH
Contact information
Practice address
1111 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3905
(218) 326-0593
Mailing address
1111 S POKEGAMA AVE, GRAND RAPIDS, MN 55744-3905
(218) 326-0593
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
115997
MN
183500000X
Pharmacist
3743
SD
Other
Enumeration date
02/12/2010
Last updated
02/12/2010
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