Provider Demographics
NPI:1073093282
Name:ROLLENDER, ERIC WILLIAM (PHAMD)
Entity Type:Individual
Prefix:DR
First Name:ERIC
Middle Name:WILLIAM
Last Name:ROLLENDER
Suffix:
Gender:M
Credentials:PHAMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5419 W LAURIE LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85302-6113
Mailing Address - Country:US
Mailing Address - Phone:480-826-6396
Mailing Address - Fax:
Practice Address - Street 1:3131 E THUNDERBIRD RD
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85032-5600
Practice Address - Country:US
Practice Address - Phone:608-992-4726
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-08-16
Last Update Date:2018-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS023481183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist