Provider Demographics
NPI:1639337462
Name:FLAHERTY, ROLLIE WHEELER (RPH,)
Entity Type:Individual
Prefix:MR
First Name:ROLLIE
Middle Name:WHEELER
Last Name:FLAHERTY
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 1:955 N KADE
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70605-7191
Mailing Address - Country:US
Mailing Address - Phone:337-562-1923
Mailing Address - Fax:
Practice Address - Street 1:955 N KADE
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-7191
Practice Address - Country:US
Practice Address - Phone:337-562-1923
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-05-29
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA16101183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist