Provider Demographics
NPI:1235657792
Name:ROOSAN, MOOM RAHMAN (PHARMD, PHD)
Entity Type:Individual
Prefix:
First Name:MOOM
Middle Name:RAHMAN
Last Name:ROOSAN
Suffix:
Gender:F
Credentials:PHARMD, PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:242 SETTLERS RD
Mailing Address - Street 2:
Mailing Address - City:UPLAND
Mailing Address - State:CA
Mailing Address - Zip Code:91786-8148
Mailing Address - Country:US
Mailing Address - Phone:260-580-1341
Mailing Address - Fax:
Practice Address - Street 1:242 SETTLERS RD
Practice Address - Street 2:
Practice Address - City:UPLAND
Practice Address - State:CA
Practice Address - Zip Code:91786-8148
Practice Address - Country:US
Practice Address - Phone:260-580-1341
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-05
Last Update Date:2017-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49401183500000X
UT8280116-1701183500000X
CA76654183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist