Provider Demographics
NPI:1063759900
Name:ROULHAC, NEENA STEMBRIDGE (RPH)
Entity type:Individual
Prefix:
First Name:NEENA
Middle Name:STEMBRIDGE
Last Name:ROULHAC
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 MOUNT ZION RD
Mailing Address - Street 2:
Mailing Address - City:MORROW
Mailing Address - State:GA
Mailing Address - Zip Code:30260-3313
Mailing Address - Country:US
Mailing Address - Phone:770-472-4006
Mailing Address - Fax:770-472-6091
Practice Address - Street 1:2035 MOUNT ZION RD
Practice Address - Street 2:
Practice Address - City:MORROW
Practice Address - State:GA
Practice Address - Zip Code:30260-3313
Practice Address - Country:US
Practice Address - Phone:770-472-4006
Practice Address - Fax:770-472-6091
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-11
Last Update Date:2013-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH019856183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist