Provider Demographics
NPI:1194005538
Name:ROSETTE, RANDY (RPH)
Entity Type:Individual
Prefix:MS
First Name:RANDY
Middle Name:
Last Name:ROSETTE
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 1:30 CENTURY HILL DRIVE
Mailing Address - Street 2:BLUE SHEILD
Mailing Address - City:LATHAM
Mailing Address - State:NY
Mailing Address - Zip Code:12110
Mailing Address - Country:US
Mailing Address - Phone:518-220-5649
Mailing Address - Fax:
Practice Address - Street 1:30 CENTURY HILL DRIVE
Practice Address - Street 2:BLUE SHEILD
Practice Address - City:LATHAM
Practice Address - State:NY
Practice Address - Zip Code:12110
Practice Address - Country:US
Practice Address - Phone:518-220-5649
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-17
Last Update Date:2014-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY034907183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist