Provider Demographics
NPI:1174890875
Name:ROQUE, DENISE (PHARMD)
Entity type:Individual
Prefix:
First Name:DENISE
Middle Name:
Last Name:ROQUE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:25130 W 105TH TER
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66061-7654
Mailing Address - Country:US
Mailing Address - Phone:785-249-4050
Mailing Address - Fax:
Practice Address - Street 1:3537 BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64111-2501
Practice Address - Country:US
Practice Address - Phone:816-561-1933
Practice Address - Fax:816-753-5938
Is Sole Proprietor?:No
Enumeration Date:2011-11-23
Last Update Date:2020-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1-14441183500000X
MO2008027468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist