Provider Demographics
NPI:1558638478
Name:ROSEN, ADRIENNE R (RPH)
Entity Type:Individual
Prefix:MRS
First Name:ADRIENNE
Middle Name:R
Last Name:ROSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13 LAKEVIEW CT
Mailing Address - Street 2:
Mailing Address - City:ROCKAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:07866-1407
Mailing Address - Country:US
Mailing Address - Phone:973-625-1336
Mailing Address - Fax:
Practice Address - Street 1:1965 RTE 57
Practice Address - Street 2:
Practice Address - City:HACKETTSTOWN
Practice Address - State:NJ
Practice Address - Zip Code:07840-3475
Practice Address - Country:US
Practice Address - Phone:908-852-2309
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-21
Last Update Date:2011-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17787183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJ17787OtherPHARMACIST LICENSE