Provider Demographics
NPI:1760548705
Name:ROFFLER, RONALD V
Entity Type:Individual
Prefix:
First Name:RONALD
Middle Name:V
Last Name:ROFFLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6509 TRENTLAND PARK DR
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:WA
Mailing Address - Zip Code:98520-7946
Mailing Address - Country:US
Mailing Address - Phone:360-533-6009
Mailing Address - Fax:
Practice Address - Street 1:316 8TH ST
Practice Address - Street 2:
Practice Address - City:HOQUIAM
Practice Address - State:WA
Practice Address - Zip Code:98550-3606
Practice Address - Country:US
Practice Address - Phone:360-532-3061
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00007008183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist