Provider Demographics
NPI:1184226920
Name:POWELL, ROSANA EMMERICH
Entity Type:Individual
Prefix:
First Name:ROSANA
Middle Name:EMMERICH
Last Name:POWELL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 SOLOMONS ISLAND RD N
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-3915
Mailing Address - Country:US
Mailing Address - Phone:410-535-5974
Mailing Address - Fax:410-535-8725
Practice Address - Street 1:655 SOLOMONS ISLAND RD N
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678-3915
Practice Address - Country:US
Practice Address - Phone:410-535-5974
Practice Address - Fax:410-535-8725
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD11088183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist