Healthcare Provider Details

I. General information

NPI: 1023315900
Provider Name (Legal Business Name): MICHAEL ERIC ROFFMAN RPH,PHARMD,BCPP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

IV. Provider business mailing address

1310 24TH AVE S
NASHVILLE TN
37212-2637
US

V. Phone/Fax

Practice location:
  • Phone: 615-873-8536
  • Fax:
Mailing address:
  • Phone: 615-873-8536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License Number28RI0326300
License Number StateNJ
# 2
Primary TaxonomyY
Taxonomy Code1835P1300X
TaxonomyPsychiatric Pharmacist
License NumberPS44803
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: