Provider Demographics
NPI:1184840894
Name:CHIN, ROSE P (DPH)
Entity Type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:P
Last Name:CHIN
Suffix:
Gender:F
Credentials:DPH
Other - Prefix:MRS
Other - First Name:MYTRANG
Other - Middle Name:PHAM
Other - Last Name:CHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:DPH
Mailing Address - Street 1:2036 FLOWERS OAK CV
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:38138-3738
Mailing Address - Country:US
Mailing Address - Phone:901-757-2364
Mailing Address - Fax:
Practice Address - Street 1:2525 HORIZON LAKE DR
Practice Address - Street 2:SUITE 101
Practice Address - City:MEMPHIS
Practice Address - State:TN
Practice Address - Zip Code:38133-8119
Practice Address - Country:US
Practice Address - Phone:901-248-3700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-04-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS8272183500000X
TN8594183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist