Provider Demographics
NPI:1144810326
Name:ROLLINGER, JON STEVEN (RPH)
Entity type:Individual
Prefix:MR
First Name:JON
Middle Name:STEVEN
Last Name:ROLLINGER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4820 W 142 1/2 ST
Mailing Address - Street 2:
Mailing Address - City:SAVAGE
Mailing Address - State:MN
Mailing Address - Zip Code:55378-2704
Mailing Address - Country:US
Mailing Address - Phone:952-452-3680
Mailing Address - Fax:
Practice Address - Street 1:200 ALTON AVE SE
Practice Address - Street 2:
Practice Address - City:NEW PRAGUE
Practice Address - State:MN
Practice Address - Zip Code:56071-5507
Practice Address - Country:US
Practice Address - Phone:952-758-3132
Practice Address - Fax:952-758-8754
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-21
Last Update Date:2021-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN114686183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist