Provider Demographics
NPI:1558343343
Name:ROSA ANH INC
Entity Type:Organization
Organization Name:ROSA ANH INC
Other - Org Name:ROSA PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:HOAN
Authorized Official - Middle Name:
Authorized Official - Last Name:DUONG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:714-775-0692
Mailing Address - Street 1:14541 BROOKHURST ST
Mailing Address - Street 2:SUITE C5
Mailing Address - City:WESTMINSTER
Mailing Address - State:CA
Mailing Address - Zip Code:92683-5700
Mailing Address - Country:US
Mailing Address - Phone:714-775-0692
Mailing Address - Fax:714-775-0270
Practice Address - Street 1:14541 BROOKHURST ST
Practice Address - Street 2:SUITE C5
Practice Address - City:WESTMINSTER
Practice Address - State:CA
Practice Address - Zip Code:92683-5700
Practice Address - Country:US
Practice Address - Phone:714-775-0692
Practice Address - Fax:714-775-0270
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-11-16
Last Update Date:2008-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPHY44840333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPHA44840Medicaid
CA1235690001Medicare ID - Type Unspecified