Provider Demographics
NPI:1003186594
Name:ROSEN, BERNARD (PHARMACIST)
Entity Type:Individual
Prefix:MR
First Name:BERNARD
Middle Name:
Last Name:ROSEN
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11053 SW 1ST ST
Mailing Address - Street 2:
Mailing Address - City:CORAL SPRINGS
Mailing Address - State:FL
Mailing Address - Zip Code:33071-8144
Mailing Address - Country:US
Mailing Address - Phone:954-345-0181
Mailing Address - Fax:
Practice Address - Street 1:11053 SW 1ST ST
Practice Address - Street 2:
Practice Address - City:CORAL SPRINGS
Practice Address - State:FL
Practice Address - Zip Code:33071-8144
Practice Address - Country:US
Practice Address - Phone:954-345-0181
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-12-30
Last Update Date:2011-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS 26011183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist