Provider Demographics
NPI:1811170574
Name:ROLLMAN, MAUREEN ELIZABETH
Entity type:Individual
Prefix:
First Name:MAUREEN
Middle Name:ELIZABETH
Last Name:ROLLMAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MAUREEN
Other - Middle Name:ELIZABETH
Other - Last Name:BYRNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7309 HARVEST HILL RD
Mailing Address - Street 2:
Mailing Address - City:MADISON
Mailing Address - State:WI
Mailing Address - Zip Code:53717-1007
Mailing Address - Country:US
Mailing Address - Phone:608-628-2191
Mailing Address - Fax:
Practice Address - Street 1:7309 HARVEST HILL RD
Practice Address - Street 2:
Practice Address - City:MADISON
Practice Address - State:WI
Practice Address - Zip Code:53717-1007
Practice Address - Country:US
Practice Address - Phone:608-628-2191
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-17
Last Update Date:2007-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14112-040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI14112-040OtherPHARMACIST