Provider Demographics
NPI:1508295627
Name:BORST, ROSEANNA INEZ (RPH)
Entity Type:Individual
Prefix:
First Name:ROSEANNA
Middle Name:INEZ
Last Name:BORST
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ROSEANNA
Other - Middle Name:BORST
Other - Last Name:KOEHLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12940 PAVILION CT
Mailing Address - Street 2:
Mailing Address - City:UNION
Mailing Address - State:KY
Mailing Address - Zip Code:41091-7107
Mailing Address - Country:US
Mailing Address - Phone:859-384-1821
Mailing Address - Fax:
Practice Address - Street 1:1100 HANSEL AVE
Practice Address - Street 2:
Practice Address - City:FLORENCE
Practice Address - State:KY
Practice Address - Zip Code:41042-4869
Practice Address - Country:US
Practice Address - Phone:859-371-2245
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-08
Last Update Date:2017-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03331477183500000X
KY012238183500000X
TX28164183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist