Provider Demographics
NPI:1356655484
Name:HUMBLE, ROSIE (RPH)
Entity Type:Individual
Prefix:
First Name:ROSIE
Middle Name:
Last Name:HUMBLE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ROSA
Other - Middle Name:MARIA
Other - Last Name:HUMBLE
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:100 NORTH ROSEDALE ROAD
Mailing Address - Street 2:
Mailing Address - City:SILVER CITY
Mailing Address - State:NM
Mailing Address - Zip Code:88061
Mailing Address - Country:US
Mailing Address - Phone:575-534-0053
Mailing Address - Fax:575-534-9684
Practice Address - Street 1:100 NORTH ROSEDALE ROAD
Practice Address - Street 2:
Practice Address - City:SILVER CITY
Practice Address - State:NM
Practice Address - Zip Code:88061
Practice Address - Country:US
Practice Address - Phone:575-534-0053
Practice Address - Fax:575-534-9684
Is Sole Proprietor?:No
Enumeration Date:2010-07-30
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM5642183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist