Provider Demographics
NPI:1467738054
Name:ROSE, PHILLIP JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:PHILLIP
Middle Name:JAMES
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 1:3104 DIXIE HWY
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-1827
Mailing Address - Country:US
Mailing Address - Phone:859-426-0342
Mailing Address - Fax:859-426-0379
Practice Address - Street 1:3104 DIXIE HWY
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-1827
Practice Address - Country:US
Practice Address - Phone:859-426-0342
Practice Address - Fax:859-426-0379
Is Sole Proprietor?:No
Enumeration Date:2011-10-26
Last Update Date:2011-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010817183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist