Provider Demographics
NPI:1265037782
Name:ROSENTHAL, KERIANN
Entity Type:Individual
Prefix:
First Name:KERIANN
Middle Name:
Last Name:ROSENTHAL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3773 UPLAND DR
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:GA
Mailing Address - Zip Code:30066-3060
Mailing Address - Country:US
Mailing Address - Phone:404-877-8580
Mailing Address - Fax:
Practice Address - Street 1:1099 JOHNSON FERRY RD
Practice Address - Street 2:
Practice Address - City:MARIETTA
Practice Address - State:GA
Practice Address - Zip Code:30068-2109
Practice Address - Country:US
Practice Address - Phone:770-973-1810
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-02
Last Update Date:2020-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH024670183500000X
GA024670183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist