Provider Demographics
NPI:1215221569
Name:ROSSLER, KEVIN (PHARM D)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:
Last Name:ROSSLER
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1831 E BROAD ST
Mailing Address - Street 2:
Mailing Address - City:MANSFIELD
Mailing Address - State:TX
Mailing Address - Zip Code:76063-9170
Mailing Address - Country:US
Mailing Address - Phone:817-477-2525
Mailing Address - Fax:174-734-1368
Practice Address - Street 1:1831 E BROAD ST
Practice Address - Street 2:
Practice Address - City:MANSFIELD
Practice Address - State:TX
Practice Address - Zip Code:76063-9170
Practice Address - Country:US
Practice Address - Phone:817-477-2525
Practice Address - Fax:817-473-4136
Is Sole Proprietor?:No
Enumeration Date:2011-06-03
Last Update Date:2019-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX48097183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist