Provider Demographics
NPI:1841505146
Name:POLLARD, ALICE M (RD, LD)
Entity type:Individual
Prefix:
First Name:ALICE
Middle Name:M
Last Name:POLLARD
Suffix:
Gender:F
Credentials:RD, LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 TIMBERVIEW DR
Mailing Address - Street 2:
Mailing Address - City:MARYSVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43040-9295
Mailing Address - Country:US
Mailing Address - Phone:937-642-7599
Mailing Address - Fax:
Practice Address - Street 1:515 TIMBERVIEW DR
Practice Address - Street 2:
Practice Address - City:MARYSVILLE
Practice Address - State:OH
Practice Address - Zip Code:43040-9295
Practice Address - Country:US
Practice Address - Phone:937-642-7599
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-08-11
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHLD 2242133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered