Provider Demographics
NPI:1407398068
Name:ROLLINS, MICHELE (RPH)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:ROLLINS
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 1:105 ELM ST
Mailing Address - Street 2:
Mailing Address - City:OLD SAYBROOK
Mailing Address - State:CT
Mailing Address - Zip Code:06475-4132
Mailing Address - Country:US
Mailing Address - Phone:860-388-6461
Mailing Address - Fax:844-411-6478
Practice Address - Street 1:105 ELM ST
Practice Address - Street 2:
Practice Address - City:OLD SAYBROOK
Practice Address - State:CT
Practice Address - Zip Code:06475-4132
Practice Address - Country:US
Practice Address - Phone:860-388-6461
Practice Address - Fax:844-411-6478
Is Sole Proprietor?:No
Enumeration Date:2016-11-14
Last Update Date:2021-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT8014183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist