Peter Hayden Roth, PHARMD

Primary specialty

PharmacistTaxonomy code 183500000X

License

21034-40 Issued in WI

Practice address

401 E Green Bay St
Shawano, WI 54166-2541

Phone

(715) 524-5600

Fax

(715) 524-5050

NPI assigned

Jul 27, 2021

Sex

Male

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Doctor of Pharmacy

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Walgreen Co

  • Pharmacy
  • Longview, TX
  • NPI 1629956545
  NPD (past)

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1627344000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1627344000000",
    "number": "1003589946",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "W5745 ERIC CT",
            "city": "PLYMOUTH",
            "state": "WI",
            "postal_code": "530733521",
            "telephone_number": "920-207-7677"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "401 E GREEN BAY ST",
            "city": "SHAWANO",
            "state": "WI",
            "postal_code": "541662541",
            "telephone_number": "715-524-5600",
            "fax_number": "715-524-5050"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "ROTH",
        "first_name": "PETER",
        "middle_name": "HAYDEN",
        "credential": "PHARMD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2021-07-27",
        "last_updated": "2021-07-27",
        "certification_date": "2021-07-27",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "183500000X",
            "taxonomy_group": "",
            "desc": "Pharmacist",
            "state": "WI",
            "license": "21034-40",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• David Richter, MD
• Jane Ellen Ritland, RN
• Laurie Ann Roberts, LCSW
• Kelly E Rogers, C.O.T.A.
• Amanda Ronsman
• Ashley Rottier
• Sharisa M Ruh, PA
• Laura Runge, MS, OTR/L
• Nicole Lee Ruske, MD
• Bethany Rae Rybarczyk, BCBA

• Pharmacist in Shawano, WI
• Providers in Shawano, WI by specialty
• Pharmacist in Wisconsin

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 27, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.