Provider Demographics
NPI:1609991306
Name:ROSSITER, JANE M (RPH)
Entity Type:Individual
Prefix:MRS
First Name:JANE
Middle Name:M
Last Name:ROSSITER
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 1:26590 WATERBURY CIR
Mailing Address - Street 2:
Mailing Address - City:NORTH OLMSTED
Mailing Address - State:OH
Mailing Address - Zip Code:44070-1870
Mailing Address - Country:US
Mailing Address - Phone:440-777-0079
Mailing Address - Fax:440-777-0079
Practice Address - Street 1:28974 LORAIN RD
Practice Address - Street 2:
Practice Address - City:NORTH OLMSTED
Practice Address - State:OH
Practice Address - Zip Code:44070-4014
Practice Address - Country:US
Practice Address - Phone:440-777-4524
Practice Address - Fax:440-777-2810
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-3-14388183500000X
IA15978183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0661805Medicaid