Provider Demographics
NPI:1093038036
Name:ROSENBLUM, ALAN S (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:S
Last Name:ROSENBLUM
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 1:161 JORDAN BLVD
Mailing Address - Street 2:
Mailing Address - City:DELMAR
Mailing Address - State:NY
Mailing Address - Zip Code:12054-4132
Mailing Address - Country:US
Mailing Address - Phone:518-439-4999
Mailing Address - Fax:
Practice Address - Street 1:392 FEURA BUSH RD
Practice Address - Street 2:
Practice Address - City:GLENMONT
Practice Address - State:NY
Practice Address - Zip Code:12077-2954
Practice Address - Country:US
Practice Address - Phone:518-462-5507
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-04
Last Update Date:2010-03-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047588183500000X
MA23250183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist