Provider Demographics
NPI:1235741240
Name:ROOSA, SYDNEY KATHERINE (PHARMD)
Entity Type:Individual
Prefix:
First Name:SYDNEY
Middle Name:KATHERINE
Last Name:ROOSA
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1700 STATE ST APT 457
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37203-3055
Mailing Address - Country:US
Mailing Address - Phone:615-734-9846
Mailing Address - Fax:
Practice Address - Street 1:2975 FORT CAMPBELL BLVD
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37042-3021
Practice Address - Country:US
Practice Address - Phone:931-431-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-08-20
Last Update Date:2020-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN43350183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist