Provider Demographics
NPI:1053665265
Name:DORNBLASER, ELIZABETH ROLLER
Entity Type:Individual
Prefix:MRS
First Name:ELIZABETH
Middle Name:ROLLER
Last Name:DORNBLASER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 2131
Mailing Address - Street 2:868 COTTESMORE LANE
Mailing Address - City:CAMDEN
Mailing Address - State:SC
Mailing Address - Zip Code:29020-8003
Mailing Address - Country:US
Mailing Address - Phone:803-424-1480
Mailing Address - Fax:
Practice Address - Street 1:2500 BROAD ST
Practice Address - Street 2:
Practice Address - City:CAMDEN
Practice Address - State:SC
Practice Address - Zip Code:29020-2225
Practice Address - Country:US
Practice Address - Phone:803-432-5103
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-11-09
Last Update Date:2012-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC46801835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist