Provider Demographics
NPI:1508497835
Name:ROSE, KESHIA (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:KESHIA
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1401 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:SUFFOLK
Mailing Address - State:VA
Mailing Address - Zip Code:23434-4352
Mailing Address - Country:US
Mailing Address - Phone:757-539-4834
Mailing Address - Fax:757-539-2076
Practice Address - Street 1:1401 N MAIN ST
Practice Address - Street 2:
Practice Address - City:SUFFOLK
Practice Address - State:VA
Practice Address - Zip Code:23434-4352
Practice Address - Country:US
Practice Address - Phone:757-539-4834
Practice Address - Fax:757-539-2076
Is Sole Proprietor?:No
Enumeration Date:2020-01-27
Last Update Date:2020-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA02022129941835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist