Healthcare Provider Details

I. General information

NPI: 1710238456
Provider Name (Legal Business Name): FRANK D ROLAND PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/20/2012
Last Update Date: 09/20/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2501 BUENA VISTA DR SE
ALBUQUERQUE NM
87106-4260
US

IV. Provider business mailing address

2501 BUENA VISTA DR SE
ALBUQUERQUE NM
87106-4260
US

V. Phone/Fax

Practice location:
  • Phone: 505-923-5585
  • Fax: 505-923-5907
Mailing address:
  • Phone: 505-923-5585
  • Fax: 505-923-5907

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302R00000X
TaxonomyHealth Maintenance Organization
License NumberRP00006067
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: