Provider Demographics
NPI:1003199167
Name:ROLSTON, LARRY WAYNE (PHARMD)
Entity Type:Individual
Prefix:
First Name:LARRY
Middle Name:WAYNE
Last Name:ROLSTON
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 1:24203 COUNTY ROAD 22
Mailing Address - Street 2:
Mailing Address - City:ESPARTO
Mailing Address - State:CA
Mailing Address - Zip Code:95627-2119
Mailing Address - Country:US
Mailing Address - Phone:530-787-4444
Mailing Address - Fax:530-787-4455
Practice Address - Street 1:24203 COUNTY ROAD 22
Practice Address - Street 2:
Practice Address - City:ESPARTO
Practice Address - State:CA
Practice Address - Zip Code:95627-2119
Practice Address - Country:US
Practice Address - Phone:530-787-4444
Practice Address - Fax:530-787-4455
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH282651835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist