Provider Demographics
NPI:1619279031
Name:ROSEMAN, BERNARD (RX)
Entity Type:Individual
Prefix:
First Name:BERNARD
Middle Name:
Last Name:ROSEMAN
Suffix:
Gender:M
Credentials:RX
Other - Prefix:
Other - First Name:BERNARD
Other - Middle Name:
Other - Last Name:ROSEMAN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RX
Mailing Address - Street 1:1071 11TH ST
Mailing Address - Street 2:
Mailing Address - City:LAKEPORT
Mailing Address - State:CA
Mailing Address - Zip Code:95453-4105
Mailing Address - Country:US
Mailing Address - Phone:707-263-8779
Mailing Address - Fax:
Practice Address - Street 1:1071 11TH ST
Practice Address - Street 2:
Practice Address - City:LAKEPORT
Practice Address - State:CA
Practice Address - Zip Code:95453-4105
Practice Address - Country:US
Practice Address - Phone:707-263-8779
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-11-18
Last Update Date:2010-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23895183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist