Provider Demographics
NPI:1508479932
Name:NYE, ROLLIE C III (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROLLIE
Middle Name:C
Last Name:NYE
Suffix:III
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2460 N FRANKLIN ST
Mailing Address - Street 2:
Mailing Address - City:CHRISTIANSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:24073-1004
Mailing Address - Country:US
Mailing Address - Phone:540-381-9374
Mailing Address - Fax:540-381-9414
Practice Address - Street 1:2460 N FRANKLIN ST
Practice Address - Street 2:
Practice Address - City:CHRISTIANSBURG
Practice Address - State:VA
Practice Address - Zip Code:24073-1004
Practice Address - Country:US
Practice Address - Phone:540-381-9374
Practice Address - Fax:540-381-9414
Is Sole Proprietor?:No
Enumeration Date:2020-08-25
Last Update Date:2020-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202214969183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist