Individual
DR. KYLE JACOB ROXBY
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
2122 ISLAND AVENUE, #201, LA GRANDE, OR 97850
(541) 893-8696
Mailing address
2122 ISLAND AVENUE, #201, LA GRANDE, OR 97850
(541) 893-8696
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
RPH-0016784
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
RPH-0016784
PHARMACIST LICENSE
OR
Enumeration date
09/05/2018
Last updated
09/05/2018
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