Healthcare Provider Details

I. General information

NPI: 1265987127
Provider Name (Legal Business Name): ROLLIES PHARMACY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/22/2016
Last Update Date: 01/23/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

128 CROSS KEYS RD
BERLIN NJ
08009-9201
US

IV. Provider business mailing address

128 CROSS KEYS RD
BERLIN NJ
08009-9201
US

V. Phone/Fax

Practice location:
  • Phone: 856-210-1515
  • Fax:
Mailing address:
  • Phone: 856-210-1515
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number28RS00749900
License Number StateNJ

VIII. Authorized Official

Name: DERRY HOLLAND
Title or Position: CEO
Credential:
Phone: 609-267-4969