Provider Demographics
NPI:1326572082
Name:ROMPH, REBECCA (RPH)
Entity Type:Individual
Prefix:
First Name:REBECCA
Middle Name:
Last Name:ROMPH
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 1:322 E MICHIGAN AVE
Mailing Address - Street 2:
Mailing Address - City:PAW PAW
Mailing Address - State:MI
Mailing Address - Zip Code:49079-1408
Mailing Address - Country:US
Mailing Address - Phone:269-657-6073
Mailing Address - Fax:269-657-3936
Practice Address - Street 1:322 E MICHIGAN AVE
Practice Address - Street 2:
Practice Address - City:PAW PAW
Practice Address - State:MI
Practice Address - Zip Code:49079-1408
Practice Address - Country:US
Practice Address - Phone:269-657-6073
Practice Address - Fax:269-657-3936
Is Sole Proprietor?:No
Enumeration Date:2017-04-19
Last Update Date:2017-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027023183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist