Provider Demographics
NPI:1023684685
Name:ROHALEY, DEIDRE J (PHARMD, MBA, BCPS)
Entity type:Individual
Prefix:
First Name:DEIDRE
Middle Name:J
Last Name:ROHALEY
Suffix:
Gender:F
Credentials:PHARMD, MBA, BCPS
Other - Prefix:
Other - First Name:DEIDRE
Other - Middle Name:J
Other - Last Name:COLLETTE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2213 CHERRY ST
Mailing Address - Street 2:
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43608-2603
Mailing Address - Country:US
Mailing Address - Phone:419-251-5306
Mailing Address - Fax:
Practice Address - Street 1:2213 CHERRY ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43608-2603
Practice Address - Country:US
Practice Address - Phone:419-251-5306
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-02
Last Update Date:2021-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020387221835P1200X
OH033285351835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy