Provider Demographics
NPI:1598802068
Name:ROSELAWN PHARMACY INC
Entity Type:Organization
Organization Name:ROSELAWN PHARMACY INC
Other - Org Name:ROSELAWN PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT,PIC,AO
Authorized Official - Prefix:
Authorized Official - First Name:JASON
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DORSEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:513-761-1212
Mailing Address - Street 1:7601 READING RD
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45237-3203
Mailing Address - Country:US
Mailing Address - Phone:513-761-1212
Mailing Address - Fax:513-761-4647
Practice Address - Street 1:7601 READING RD
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45237-3203
Practice Address - Country:US
Practice Address - Phone:513-761-1212
Practice Address - Fax:513-761-4647
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2022-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
332B00000X, 333600000X
OHRTP0201042503336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2074396OtherPK
OH7504203Medicaid
2074396OtherPK