Provider Demographics
NPI:1548796436
Name:ROSE, ANDREA (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANDREA
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 1:300 TOWNE CENTER DR
Mailing Address - Street 2:
Mailing Address - City:ABINGDON
Mailing Address - State:VA
Mailing Address - Zip Code:24210-3248
Mailing Address - Country:US
Mailing Address - Phone:276-628-2190
Mailing Address - Fax:
Practice Address - Street 1:300 TOWNE CENTER DR
Practice Address - Street 2:
Practice Address - City:ABINGDON
Practice Address - State:VA
Practice Address - Zip Code:24210-3248
Practice Address - Country:US
Practice Address - Phone:276-628-2190
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-11
Last Update Date:2017-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202215364183500000X
TN40909183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist