Larry Wayne Rolston, PHARM.D.

Individual provider Active NPI Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist · Esparto, CA

NPI 1003199167 · NPPES record last updated Sep 26, 2011

Key facts

NPI
1003199167
Entity type
Individual (NPI type 1)
Primary specialty
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X
License
RPH28265 (CA)
Practice address
24203 County Road 22
Esparto, CA 95627-2119
Phone
(530) 787-4444
Fax
(530) 787-4455
NPI assigned
Sep 26, 2011
Sex
Male
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No
Credentials
Doctor of Pharmacy

State licenses

LicenseStateTypeSpecialty
RPH28265CAMDPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist 1835P0018X RPH28265 CA Yes

Addresses

Primary practice location

24203 County Road 22
Esparto, CA 95627-2119

Mailing address

24203 County Road 22
Esparto, CA 95627-2119
Phone (530) 787-4444

Other providers in Esparto, CA

All providers in Esparto, CA · Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist in California

Sources for this page

Verify at the official NPI Registry.