Provider Demographics
NPI:1306027974
Name:ROSENBERG, ELLEN JAYNE (RPH)
Entity Type:Individual
Prefix:
First Name:ELLEN
Middle Name:JAYNE
Last Name:ROSENBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BUFFALO
Mailing Address - State:NY
Mailing Address - Zip Code:14202-3203
Mailing Address - Country:US
Mailing Address - Phone:716-854-3387
Mailing Address - Fax:716-854-4111
Practice Address - Street 1:452 MAIN ST
Practice Address - Street 2:
Practice Address - City:BUFFALO
Practice Address - State:NY
Practice Address - Zip Code:14202-3203
Practice Address - Country:US
Practice Address - Phone:716-854-3387
Practice Address - Fax:716-854-4111
Is Sole Proprietor?:No
Enumeration Date:2007-11-23
Last Update Date:2007-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY34208183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist