Provider Demographics
NPI:1003804436
Name:ROSAUERS SUPERMARKETS INC
Entity Type:Organization
Organization Name:ROSAUERS SUPERMARKETS INC
Other - Org Name:ROSAUERS PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILPPS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-326-8900
Mailing Address - Street 1:PO BOX 9000
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99209-9000
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2350 S RESERVE ST
Practice Address - Street 2:
Practice Address - City:MISSOULA
Practice Address - State:MT
Practice Address - Zip Code:59801-6447
Practice Address - Country:US
Practice Address - Phone:406-721-5330
Practice Address - Fax:406-721-4832
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2007-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
MT672MT3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2703266OtherOTHER ID NUMBER
MT05600725Medicaid
MT05600725Medicaid