Provider Demographics
NPI:1568936961
Name:ANGEL ROSE LTC PHARMACY INC
Entity Type:Organization
Organization Name:ANGEL ROSE LTC PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/PHARMACIST-IN-CHARGE
Authorized Official - Prefix:
Authorized Official - First Name:ROSALINA
Authorized Official - Middle Name:BRAVO
Authorized Official - Last Name:CANTURIA
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:442-286-7127
Mailing Address - Street 1:365 W 2ND AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:ESCONDIDO
Mailing Address - State:CA
Mailing Address - Zip Code:92025-4136
Mailing Address - Country:US
Mailing Address - Phone:442-286-7127
Mailing Address - Fax:442-286-7113
Practice Address - Street 1:365 W 2ND AVE STE 103
Practice Address - Street 2:
Practice Address - City:ESCONDIDO
Practice Address - State:CA
Practice Address - Zip Code:92025-4136
Practice Address - Country:US
Practice Address - Phone:442-286-7127
Practice Address - Fax:442-286-7113
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-01-18
Last Update Date:2019-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty