Provider Demographics
NPI:1033706064
Name:ROSEN, JEFFREY A (RPH)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:A
Last Name:ROSEN
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 1:32 WEST RD STE 100
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2321
Mailing Address - Country:US
Mailing Address - Phone:410-823-1818
Mailing Address - Fax:410-823-1888
Practice Address - Street 1:32 WEST RD STE 100
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21204-2321
Practice Address - Country:US
Practice Address - Phone:410-823-1818
Practice Address - Fax:410-823-1888
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD91743336C0003X, 183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy