Provider Demographics
NPI:1689892192
Name:THACKER, ROXANNE V (PHARM D)
Entity type:Individual
Prefix:DR
First Name:ROXANNE
Middle Name:V
Last Name:THACKER
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1478 N 260 E
Mailing Address - Street 2:
Mailing Address - City:PLEASANT GROVE
Mailing Address - State:UT
Mailing Address - Zip Code:84062-9446
Mailing Address - Country:US
Mailing Address - Phone:801-785-7855
Mailing Address - Fax:
Practice Address - Street 1:1653 W 9000 S
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-9221
Practice Address - Country:US
Practice Address - Phone:801-561-7497
Practice Address - Fax:801-561-1813
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT353442-1701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist