Provider Demographics
NPI:1326700170
Name:ROTHERHAM, REBECCA A (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:A
Last Name:ROTHERHAM
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:REBECCA
Other - Middle Name:A
Other - Last Name:MATHANY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1111 6TH AVENUE
Mailing Address - Street 2:
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50314
Mailing Address - Country:US
Mailing Address - Phone:515-643-4429
Mailing Address - Fax:515-643-8965
Practice Address - Street 1:1111 6TH AVENUE
Practice Address - Street 2:
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50314
Practice Address - Country:US
Practice Address - Phone:515-643-4429
Practice Address - Fax:515-643-8965
Is Sole Proprietor?:No
Enumeration Date:2021-10-08
Last Update Date:2021-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA18363183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist