MEDICARE: NEENA STEMBRIDGE ROULHAC RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	RPH019856	GA

General Provider Information

NPI Number	:	1063759900
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NEENA STEMBRIDGE ROULHAC RPH

Provider Business Mailing Address
First Line	:	2035 MOUNT ZION RD
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-3313
Country	:	US
Telephone Number	:	770-472-4006
Fax Number	:	770-472-6091

Provider Business Practice Location Address
First Line	:	2035 MOUNT ZION RD
Second Line	:
City	:	MORROW
State	:	GA
Zip	:	30260-3313
Country	:	US
Telephone Number	:	770-472-4006
Fax Number	:	770-472-6091

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/11/2013
Last Update Date	:	01/11/2013

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