Provider Demographics
NPI:1407450257
Name:ROSE, PHILIP JOE (RPH)
Entity Type:Individual
Prefix:MR
First Name:PHILIP
Middle Name:JOE
Last Name:ROSE
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 1:4109 MOORGATE CIR
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-9783
Mailing Address - Country:US
Mailing Address - Phone:405-314-6074
Mailing Address - Fax:
Practice Address - Street 1:5401 TINKER DIAG ST
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-4622
Practice Address - Country:US
Practice Address - Phone:405-670-1030
Practice Address - Fax:405-670-1036
Is Sole Proprietor?:No
Enumeration Date:2020-11-23
Last Update Date:2020-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK10782183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist