Provider Demographics
NPI:1063825362
Name:ROSE, SHAYLA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:SHAYLA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3140 TURNER HILL RD
Mailing Address - Street 2:
Mailing Address - City:LITHONIA
Mailing Address - State:GA
Mailing Address - Zip Code:30038-2530
Mailing Address - Country:US
Mailing Address - Phone:678-323-8559
Mailing Address - Fax:
Practice Address - Street 1:3140 TURNER HILL RD
Practice Address - Street 2:
Practice Address - City:LITHONIA
Practice Address - State:GA
Practice Address - Zip Code:30038-2530
Practice Address - Country:US
Practice Address - Phone:678-323-8559
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2014-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH027310183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GARPH-027310OtherGEORGIA STATE BOARD OF PHARMACY