Provider Demographics
NPI:1134111354
Name:ROSENBERG, GAIL LINDA (RPH)
Entity Type:Individual
Prefix:
First Name:GAIL
Middle Name:LINDA
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3501 FOREST EDGE DR
Mailing Address - Street 2:APT 1G
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-1547
Mailing Address - Country:US
Mailing Address - Phone:301-598-4195
Mailing Address - Fax:
Practice Address - Street 1:3305 N LEISURE WORLD BLVD
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-1367
Practice Address - Country:US
Practice Address - Phone:301-598-1005
Practice Address - Fax:301-598-1548
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-08-16
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD08962183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2111172OtherNCPDP
MD0746160001Medicare ID - Type Unspecified