Provider Demographics
NPI:1437160066
Name:ROSEBILL PHARMACY CORP
Entity Type:Organization
Organization Name:ROSEBILL PHARMACY CORP
Other - Org Name:MID VALLEY PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:WONG
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:805-527-4013
Mailing Address - Street 1:2519 ROYAL AVE
Mailing Address - Street 2:
Mailing Address - City:SIMI VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:93065-4700
Mailing Address - Country:US
Mailing Address - Phone:805-527-4013
Mailing Address - Fax:805-527-3756
Practice Address - Street 1:2519 ROYAL AVE
Practice Address - Street 2:
Practice Address - City:SIMI VALLEY
Practice Address - State:CA
Practice Address - Zip Code:93065-4700
Practice Address - Country:US
Practice Address - Phone:805-527-4013
Practice Address - Fax:805-527-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-10
Last Update Date:2018-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
CAPHY474233336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
1992041OtherPK
CAPHA307760Medicaid