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NPI Code Detail

MEDICARE: MR. MITCHELL LEE ROLLIE

MEDICARE:  MR. MITCHELL LEE ROLLIE
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
1183500000XPharmacist121057MN

General Provider Information

NPI Number : 1154671261
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. MITCHELL LEE ROLLIE
Provider Business Mailing Address
First Line : 700 DIVISION ST S
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-2427
Country : US
Telephone Number : 507-645-4455
Fax Number : 507-645-6912
Provider Business Practice Location Address
First Line : 700 DIVISION ST S
Second Line :
City : NORTHFIELD
State : MN
Zip : 55057-2427
Country : US
Telephone Number : 507-645-4455
Fax Number : 507-645-6912
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/16/2012
Last Update Date : 11/21/2019

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Directions to “ MR. MITCHELL LEE ROLLIE ” Practice Location

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