Healthcare Provider Details

I. General information

NPI: 1598267775
Provider Name (Legal Business Name): TONJA MARIE ROLAND-LUDWIG RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/05/2018
Last Update Date: 03/05/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2104 KIMBALL AVE
WATERLOO IA
50702-5037
US

IV. Provider business mailing address

2104 KIMBALL AVE
WATERLOO IA
50702-5037
US

V. Phone/Fax

Practice location:
  • Phone: 319-234-6673
  • Fax:
Mailing address:
  • Phone: 319-234-6673
  • Fax: 319-226-5898

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number18064
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: