Provider Demographics
NPI:1336751171
Name:ROLWING, ANDREA SMITH (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ANDREA
Middle Name:SMITH
Last Name:ROLWING
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:DR
Other - First Name:ANDREA
Other - Middle Name:SMITH
Other - Last Name:ROLWING
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARMD
Mailing Address - Street 1:1500 N WESTWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-3318
Mailing Address - Country:US
Mailing Address - Phone:573-686-4151
Mailing Address - Fax:
Practice Address - Street 1:903 S KINGSHIGHWAY ST
Practice Address - Street 2:
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-4415
Practice Address - Country:US
Practice Address - Phone:573-472-2139
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-22
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20160290501835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist