Provider Demographics
NPI:1003931171
Name:ROSE, DOCK HENRY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOCK
Middle Name:HENRY
Last Name:ROSE
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 1:105 SUGAR CREEK RD
Mailing Address - Street 2:
Mailing Address - City:GREER
Mailing Address - State:SC
Mailing Address - Zip Code:29650-3022
Mailing Address - Country:US
Mailing Address - Phone:864-609-5178
Mailing Address - Fax:864-848-8282
Practice Address - Street 1:313 MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:GREER
Practice Address - State:SC
Practice Address - Zip Code:29650-1522
Practice Address - Country:US
Practice Address - Phone:864-848-8165
Practice Address - Fax:864-848-8282
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC03529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist