Provider Demographics
NPI:1518443340
Name:ROBINSON, ROSE L (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:L
Last Name:ROBINSON
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 1:1589 SIERRA VISTA PLZ
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-2040
Mailing Address - Country:US
Mailing Address - Phone:314-355-8314
Mailing Address - Fax:314-355-3591
Practice Address - Street 1:1589 SIERRA VISTA PLZ
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-2040
Practice Address - Country:US
Practice Address - Phone:314-355-8314
Practice Address - Fax:314-355-3591
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-15
Last Update Date:2018-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2008029239183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist