Provider Demographics
NPI:1619320074
Name:ROLLINS, CORINE KAYLA (PHARMD, RPH)
Entity Type:Individual
Prefix:DR
First Name:CORINE
Middle Name:KAYLA
Last Name:ROLLINS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:424 SERENE CT
Mailing Address - Street 2:
Mailing Address - City:IRMO
Mailing Address - State:SC
Mailing Address - Zip Code:29063-7792
Mailing Address - Country:US
Mailing Address - Phone:717-729-3789
Mailing Address - Fax:
Practice Address - Street 1:1355 KNOX ABBOTT DR
Practice Address - Street 2:
Practice Address - City:CAYCE
Practice Address - State:SC
Practice Address - Zip Code:29033-3327
Practice Address - Country:US
Practice Address - Phone:803-223-0754
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC36685183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist