Provider Demographics
NPI:1356630669
Name:ROLLINS, BRENT (RPH, PHD)
Entity type:Individual
Prefix:DR
First Name:BRENT
Middle Name:
Last Name:ROLLINS
Suffix:
Gender:M
Credentials:RPH, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2528 MORNINGSIDE DR
Mailing Address - Street 2:
Mailing Address - City:BOGART
Mailing Address - State:GA
Mailing Address - Zip Code:30622-5853
Mailing Address - Country:US
Mailing Address - Phone:706-769-7221
Mailing Address - Fax:
Practice Address - Street 1:2065 EXPERIMENT STATION RD
Practice Address - Street 2:
Practice Address - City:WATKINSVILLE
Practice Address - State:GA
Practice Address - Zip Code:30677-5321
Practice Address - Country:US
Practice Address - Phone:706-769-5654
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH022285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist