Provider Demographics
NPI:1679803779
Name:ROLON, ANIBAL (RPH)
Entity type:Individual
Prefix:MR
First Name:ANIBAL
Middle Name:
Last Name:ROLON
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 1:955 WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33139-5015
Mailing Address - Country:US
Mailing Address - Phone:305-531-1256
Mailing Address - Fax:305-531-0562
Practice Address - Street 1:955 WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MIAMI BEACH
Practice Address - State:FL
Practice Address - Zip Code:33139-5015
Practice Address - Country:US
Practice Address - Phone:305-531-1256
Practice Address - Fax:305-531-0562
Is Sole Proprietor?:No
Enumeration Date:2010-01-12
Last Update Date:2015-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS013608183500000X
PR2518183500000X
FLPS50190183500000X
NY33699183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist