Provider Demographics
NPI:1316585581
Name:ROSENBAUM, DEBORAH MAGOUN (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:MAGOUN
Last Name:ROSENBAUM
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:DEBORAH.ROSENBAUM@STORES.KROGER.COM
Mailing Address - Street 2:4910 I-55 NORTH
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39211
Mailing Address - Country:US
Mailing Address - Phone:601-366-6554
Mailing Address - Fax:601-987-8382
Practice Address - Street 1:DEBORAH.ROSENBAUM@STORES.KROGER.COM
Practice Address - Street 2:4910 I-55 NORTH
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39211
Practice Address - Country:US
Practice Address - Phone:601-366-6554
Practice Address - Fax:601-987-8382
Is Sole Proprietor?:No
Enumeration Date:2019-12-18
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE-076321835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist