Provider Demographics
NPI:1871652685
Name:RODEWALD, ANTHONY E (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANTHONY
Middle Name:E
Last Name:RODEWALD
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:71824 CALABRIA DR
Mailing Address - Street 2:
Mailing Address - City:MCCOOK
Mailing Address - State:NE
Mailing Address - Zip Code:69001-7278
Mailing Address - Country:US
Mailing Address - Phone:308-345-3017
Mailing Address - Fax:308-345-8558
Practice Address - Street 1:1301 E H ST
Practice Address - Street 2:
Practice Address - City:MCCOOK
Practice Address - State:NE
Practice Address - Zip Code:69001-3482
Practice Address - Country:US
Practice Address - Phone:308-345-8258
Practice Address - Fax:308-345-8558
Is Sole Proprietor?:No
Enumeration Date:2006-12-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE11888183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist