Provider Demographics
NPI:1811306707
Name:ROTELLI, ALAINA (PHARMD)
Entity type:Individual
Prefix:
First Name:ALAINA
Middle Name:
Last Name:ROTELLI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1308 EVERETT AVE
Mailing Address - Street 2:APARTMENT #3
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40204-2232
Mailing Address - Country:US
Mailing Address - Phone:203-767-9449
Mailing Address - Fax:
Practice Address - Street 1:2100 GARDINER LANE
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40205
Practice Address - Country:US
Practice Address - Phone:502-413-8991
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-08-05
Last Update Date:2014-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26025708A183500000X
KY017302183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist