Provider Demographics
NPI:1275133563
Name:ROLF, CONNIE SUE (RPH)
Entity Type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:SUE
Last Name:ROLF
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 1:12758 HIGHWAY 23
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MO
Mailing Address - Zip Code:64001-8147
Mailing Address - Country:US
Mailing Address - Phone:660-815-7278
Mailing Address - Fax:
Practice Address - Street 1:3201 W BROADWAY BLVD
Practice Address - Street 2:
Practice Address - City:SEDALIA
Practice Address - State:MO
Practice Address - Zip Code:65301-2118
Practice Address - Country:US
Practice Address - Phone:660-826-2144
Practice Address - Fax:660-827-1906
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-27
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO041852183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist