Provider Demographics
NPI:1407198070
Name:DOPPLICK, ROSE (RPH)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:
Last Name:DOPPLICK
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 1:550 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-3901
Mailing Address - Country:US
Mailing Address - Phone:928-649-3850
Mailing Address - Fax:
Practice Address - Street 1:550 S MAIN ST
Practice Address - Street 2:
Practice Address - City:COTTONWOOD
Practice Address - State:AZ
Practice Address - Zip Code:86326-3901
Practice Address - Country:US
Practice Address - Phone:928-649-3850
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-03-21
Last Update Date:2013-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS12462183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist