Provider Demographics
NPI:1487084232
Name:ROGALLA, RODNEY LEE (RPH)
Entity type:Individual
Prefix:
First Name:RODNEY
Middle Name:LEE
Last Name:ROGALLA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 E GRAND AVE
Mailing Address - Street 2:
Mailing Address - City:ROTHSCHILD
Mailing Address - State:WI
Mailing Address - Zip Code:54474-1024
Mailing Address - Country:US
Mailing Address - Phone:715-359-4251
Mailing Address - Fax:715-359-0145
Practice Address - Street 1:1105 E GRAND AVE
Practice Address - Street 2:
Practice Address - City:ROTHSCHILD
Practice Address - State:WI
Practice Address - Zip Code:54474-1024
Practice Address - Country:US
Practice Address - Phone:715-359-4251
Practice Address - Fax:715-359-0145
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-14
Last Update Date:2013-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI867340183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist