Provider Demographics
NPI:1558965921
Name:CHACKO, ROSEMARY (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:
Last Name:CHACKO
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 1:4000 E BAY DR
Mailing Address - Street 2:
Mailing Address - City:CLEARWATER
Mailing Address - State:FL
Mailing Address - Zip Code:33764-6975
Mailing Address - Country:US
Mailing Address - Phone:727-532-4157
Mailing Address - Fax:
Practice Address - Street 1:4000 E BAY DR
Practice Address - Street 2:
Practice Address - City:CLEARWATER
Practice Address - State:FL
Practice Address - Zip Code:33764-6975
Practice Address - Country:US
Practice Address - Phone:727-532-4157
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-25
Last Update Date:2020-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS56472183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist