Provider Demographics
NPI:1457651275
Name:ROULLIER, SCOTT (RPH)
Entity Type:Individual
Prefix:MR
First Name:SCOTT
Middle Name:
Last Name:ROULLIER
Suffix:
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 1:800 W BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:MISSOULA
Mailing Address - State:MT
Mailing Address - Zip Code:59802-3944
Mailing Address - Country:US
Mailing Address - Phone:406-721-6009
Mailing Address - Fax:406-721-6021
Practice Address - Street 1:800 W BROADWAY ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59802-3944
Practice Address - Country:US
Practice Address - Phone:406-721-6009
Practice Address - Fax:406-721-6021
Is Sole Proprietor?:No
Enumeration Date:2010-10-26
Last Update Date:2010-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT3791183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist