Provider Demographics
NPI:1588901623
Name:ROLLER, AIMEE MONIQUE (RPH)
Entity type:Individual
Prefix:MRS
First Name:AIMEE
Middle Name:MONIQUE
Last Name:ROLLER
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 1:911 DULUTH HWY
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEVILLE
Mailing Address - State:GA
Mailing Address - Zip Code:30043-5320
Mailing Address - Country:US
Mailing Address - Phone:770-339-5606
Mailing Address - Fax:770-339-5615
Practice Address - Street 1:911 DULUTH HWY
Practice Address - Street 2:
Practice Address - City:LAWRENCEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30043-5320
Practice Address - Country:US
Practice Address - Phone:770-339-5606
Practice Address - Fax:770-339-5615
Is Sole Proprietor?:No
Enumeration Date:2013-01-09
Last Update Date:2013-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA017036183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GA017036OtherPHARMACIST LICENSE NUMBER