Provider Demographics
NPI:1083197248
Name:ROSES PHARMACY LLC
Entity Type:Organization
Organization Name:ROSES PHARMACY LLC
Other - Org Name:ROSES PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:HONG
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:504-319-8777
Mailing Address - Street 1:4704 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MARRERO
Mailing Address - State:LA
Mailing Address - Zip Code:70072-1905
Mailing Address - Country:US
Mailing Address - Phone:504-301-2900
Mailing Address - Fax:504-266-2500
Practice Address - Street 1:4704 4TH ST
Practice Address - Street 2:
Practice Address - City:MARRERO
Practice Address - State:LA
Practice Address - Zip Code:70072-1905
Practice Address - Country:US
Practice Address - Phone:504-301-2900
Practice Address - Fax:504-266-2500
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSES PHARMACY LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-09-12
Last Update Date:2022-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA2206591Medicaid