Provider Demographics
NPI:1013201169
Name:ARCHBOLD, ROSE (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:
Last Name:ARCHBOLD
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3055 COLUMBIA BLVD
Mailing Address - Street 2:TARGET PHARMACY STORE NUMBER (T-2269)
Mailing Address - City:TITUSVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32780-7865
Mailing Address - Country:US
Mailing Address - Phone:321-360-1087
Mailing Address - Fax:321-360-1097
Practice Address - Street 1:3055 COLUMBIA BLVD
Practice Address - Street 2:TARGET PHARMACY STORE NUMBER (T-2269)
Practice Address - City:TITUSVILLE
Practice Address - State:FL
Practice Address - Zip Code:32780-7865
Practice Address - Country:US
Practice Address - Phone:321-360-1087
Practice Address - Fax:321-360-1097
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2011-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37899183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist