Provider Demographics
NPI:1730457276
Name:ROTOLONI, ROBERT JOHN (RPH)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:JOHN
Last Name:ROTOLONI
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 1:804 SWAN DR
Mailing Address - Street 2:
Mailing Address - City:DYER
Mailing Address - State:IN
Mailing Address - Zip Code:46311-1076
Mailing Address - Country:US
Mailing Address - Phone:219-322-9966
Mailing Address - Fax:
Practice Address - Street 1:820 183RD ST
Practice Address - Street 2:
Practice Address - City:HOMEWOOD
Practice Address - State:IL
Practice Address - Zip Code:60430-3505
Practice Address - Country:US
Practice Address - Phone:708-957-9402
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-12
Last Update Date:2011-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051028851183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist