Provider Demographics
NPI:1487284311
Name:ROLLER, JOANNA
Entity type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:ROLLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:220 TOM HILL SR BLVD
Mailing Address - Street 2:
Mailing Address - City:MACON
Mailing Address - State:GA
Mailing Address - Zip Code:31210-1815
Mailing Address - Country:US
Mailing Address - Phone:478-474-7597
Mailing Address - Fax:478-405-5182
Practice Address - Street 1:220 TOM HILL SR BLVD
Practice Address - Street 2:
Practice Address - City:MACON
Practice Address - State:GA
Practice Address - Zip Code:31210-1815
Practice Address - Country:US
Practice Address - Phone:478-474-7597
Practice Address - Fax:478-405-5182
Is Sole Proprietor?:No
Enumeration Date:2020-01-20
Last Update Date:2020-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA155261835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist