Provider Demographics
NPI:1417279340
Name:ROHLAND, JACK W JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JACK
Middle Name:W
Last Name:ROHLAND
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6163 BROWN RD
Mailing Address - Street 2:
Mailing Address - City:BUTLER
Mailing Address - State:PA
Mailing Address - Zip Code:16002-0411
Mailing Address - Country:US
Mailing Address - Phone:724-586-2045
Mailing Address - Fax:
Practice Address - Street 1:300 PULLMAN SQUARE
Practice Address - Street 2:KMART PHARMACY #4771
Practice Address - City:BUTLER
Practice Address - State:PA
Practice Address - Zip Code:16001-5658
Practice Address - Country:US
Practice Address - Phone:724-282-2435
Practice Address - Fax:724-282-4185
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP-039177-L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
RP039177-LOtherSTATE LICENSE