Provider Demographics
NPI:1023330537
Name:ROLLEN, DANA M (PHARMD)
Entity type:Individual
Prefix:DR
First Name:DANA
Middle Name:M
Last Name:ROLLEN
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2129 ROSLYN AVE
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28208-4271
Mailing Address - Country:US
Mailing Address - Phone:704-453-9156
Mailing Address - Fax:
Practice Address - Street 1:251 EASTWAY DR
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28213-7103
Practice Address - Country:US
Practice Address - Phone:704-446-0903
Practice Address - Fax:704-446-0968
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-25
Last Update Date:2021-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC16485183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC123456789Medicaid
NC123456789Medicaid
NC1234567890Medicare PIN
NC1234567890Medicare NSC
NC1234567890Medicare UPIN