Provider Demographics
NPI:1235476193
Name:KING, ROSA ZAVALETA (PHARM D)
Entity Type:Individual
Prefix:
First Name:ROSA
Middle Name:ZAVALETA
Last Name:KING
Suffix:
Gender:F
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 1:104 ENFIELD TRCE
Mailing Address - Street 2:
Mailing Address - City:WOODSTOCK
Mailing Address - State:GA
Mailing Address - Zip Code:30189-6190
Mailing Address - Country:US
Mailing Address - Phone:770-286-4073
Mailing Address - Fax:
Practice Address - Street 1:4403 TOWNE LAKE PKWY
Practice Address - Street 2:
Practice Address - City:WOODSTOCK
Practice Address - State:GA
Practice Address - Zip Code:30189-8132
Practice Address - Country:US
Practice Address - Phone:770-516-2046
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-12
Last Update Date:2013-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0022468183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist