Active NPI
Larry T Rolle, R.PH.
- Pharmacist
- Peoria, IL
National Provider Identifier
1497763197
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Pharmacist
- Practice address
- 411 Martin Luther King Dr.
Peoria, IL 61605 - Phone
- (309) 497-0790
- Fax
- (309) 497-3567
- NPI assigned
- Aug 4, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | IL | Primary |
Addresses
Primary practice location
411 Martin Luther King Dr.
Peoria, IL 61605
Mailing address
145 Rue Vue Du Lac
East Peoria, IL 61611-1543
Phone (309) 699-9999
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Pharmacist
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 051031315 | IL | MD | Pharmacist |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1154649600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1497763197",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "145 RUE VUE DU LAC",
"city": "EAST PEORIA",
"state": "IL",
"postal_code": "616111543",
"telephone_number": "309-699-9999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "411 MARTIN LUTHER KING DR.",
"city": "PEORIA",
"state": "IL",
"postal_code": "61605",
"telephone_number": "309-497-0790",
"fax_number": "309-497-3567"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ROLLE",
"first_name": "LARRY",
"middle_name": "T",
"credential": "R.PH.",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-08-04",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "183500000X",
"taxonomy_group": "",
"desc": "Pharmacist",
"state": "IL",
"license": null,
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Peoria, IL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.