Provider Demographics
NPI:1376633834
Name:ROSEN, STANLEY LEONARD (RPH)
Entity Type:Individual
Prefix:
First Name:STANLEY
Middle Name:LEONARD
Last Name:ROSEN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9 MARIE AVE
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2542
Mailing Address - Country:US
Mailing Address - Phone:781-784-8988
Mailing Address - Fax:781-784-8988
Practice Address - Street 1:115 MILL ST
Practice Address - Street 2:MCLEAN HOSPITAL PHARMACY DEPARTMENT
Practice Address - City:BELMONT
Practice Address - State:MA
Practice Address - Zip Code:02478-1041
Practice Address - Country:US
Practice Address - Phone:617-855-3398
Practice Address - Fax:617-855-3355
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-13
Last Update Date:2014-03-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA308 HO174400000X
MA3082 NHA174400000X
MA15198183500000X, 1835G0303X, 1835P1200X, 1835P1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No174400000XOther Service ProvidersSpecialist
No1835G0303XPharmacy Service ProvidersPharmacistGeriatric
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy
No1835P1300XPharmacy Service ProvidersPharmacistPsychiatric