Provider Demographics
NPI:1619575743
Name:NIEWOEHNER, ROLAND ELROY (RPH)
Entity Type:Individual
Prefix:
First Name:ROLAND
Middle Name:ELROY
Last Name:NIEWOEHNER
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 1:3931 4TH AVE SW
Mailing Address - Street 2:
Mailing Address - City:WATERTOWN
Mailing Address - State:SD
Mailing Address - Zip Code:57201-7009
Mailing Address - Country:US
Mailing Address - Phone:605-520-9839
Mailing Address - Fax:
Practice Address - Street 1:1320 9TH AVE SE
Practice Address - Street 2:
Practice Address - City:WATERTOWN
Practice Address - State:SD
Practice Address - Zip Code:57201-5355
Practice Address - Country:US
Practice Address - Phone:605-886-0661
Practice Address - Fax:605-886-0721
Is Sole Proprietor?:No
Enumeration Date:2020-10-12
Last Update Date:2020-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDRPH4031183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist