Provider Demographics
NPI:1609190701
Name:ROSE, RICHARD A
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:A
Last Name:ROSE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7547 BUFFALO RD
Mailing Address - Street 2:
Mailing Address - City:HARBORCREEK
Mailing Address - State:PA
Mailing Address - Zip Code:16421-1214
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:105 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORTH EAST
Practice Address - State:PA
Practice Address - Zip Code:16428-1119
Practice Address - Country:US
Practice Address - Phone:814-725-3076
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-17
Last Update Date:2010-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP442329183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist