Provider Demographics
NPI:1275357709
Name:SAPITULA, ROLDAN J (PHARMD)
Entity type:Individual
Prefix:
First Name:ROLDAN
Middle Name:J
Last Name:SAPITULA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12741 Q ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68137-3211
Mailing Address - Country:US
Mailing Address - Phone:402-895-3102
Mailing Address - Fax:402-895-3155
Practice Address - Street 1:12741 Q ST
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68137-3211
Practice Address - Country:US
Practice Address - Phone:402-895-3102
Practice Address - Fax:402-895-3155
Is Sole Proprietor?:No
Enumeration Date:2024-11-12
Last Update Date:2024-11-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE18058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist