Provider Demographics
NPI:1477688661
Name:ROSE, DON H (DPH)
Entity Type:Individual
Prefix:
First Name:DON
Middle Name:H
Last Name:ROSE
Suffix:
Gender:M
Credentials:DPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:348 DEER CREEK TRL
Mailing Address - Street 2:
Mailing Address - City:WHITE PINE
Mailing Address - State:TN
Mailing Address - Zip Code:37890-4923
Mailing Address - Country:US
Mailing Address - Phone:865-674-6488
Mailing Address - Fax:
Practice Address - Street 1:1224 GAY STREET
Practice Address - Street 2:
Practice Address - City:DANDRIDGE
Practice Address - State:TN
Practice Address - Zip Code:37725
Practice Address - Country:US
Practice Address - Phone:865-397-3444
Practice Address - Fax:865-397-6279
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN4465183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4465OtherSTATE LICENSE