Provider Demographics
NPI:1790376713
Name:ALPHONSE, ROLF (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROLF
Middle Name:
Last Name:ALPHONSE
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:ROLF
Other - Middle Name:JOSE' ANTONIO
Other - Last Name:ALPHONSE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:266 RTE 44 RAYNHAM
Mailing Address - Street 2:
Mailing Address - City:RAYNHAM
Mailing Address - State:MA
Mailing Address - Zip Code:02767
Mailing Address - Country:US
Mailing Address - Phone:508-824-1361
Mailing Address - Fax:
Practice Address - Street 1:266 RTE 44 RAYNHAM
Practice Address - Street 2:
Practice Address - City:RAYNHAM
Practice Address - State:MA
Practice Address - Zip Code:02767
Practice Address - Country:US
Practice Address - Phone:508-824-1361
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-02
Last Update Date:2021-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA20739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist