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General NPI Number Information
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NPI Number | 1356989610
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Entity Type | Individual
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Provider Name | MICHELLE ANN ROLLE PHARMD
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Gender | Female
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Dates
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Enumeration Date | 12/18/2019
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Last Update Date | 12/18/2019
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Provider Practice Location Address
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Address Line | 6215 RIVERSIDE AVE
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City | RIVERSIDE
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State | CA
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Zip | 92506-2179
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Country | US
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Telephone | 951-781-0146
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Fax | 951-781-0816
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Provider Business Mailing Address
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Address Line | 7651 AYR CT
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City | RIVERSIDE
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State | CA
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Zip | 92508-6094
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Country | US
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Telephone | 951-533-6603
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 61403
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License Number State | CA
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