Provider Demographics
NPI:1023842531
Name:BALLENTINE, ROLLIN (PHARMD)
Entity type:Individual
Prefix:
First Name:ROLLIN
Middle Name:
Last Name:BALLENTINE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10415 OLD CAMP RD
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23235-3985
Mailing Address - Country:US
Mailing Address - Phone:804-305-2859
Mailing Address - Fax:
Practice Address - Street 1:10415 OLD CAMP RD
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23235-3985
Practice Address - Country:US
Practice Address - Phone:804-305-2859
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-08-27
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202009289183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist