Provider Demographics
NPI:1629251657
Name:ROSE, CATHERINE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:CATHERINE
Middle Name:
Last Name:ROSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:CATHERINE
Other - Middle Name:
Other - Last Name:IULIANO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1910 HEMPSTEAD TPKE
Mailing Address - Street 2:
Mailing Address - City:EAST MEADOW
Mailing Address - State:NY
Mailing Address - Zip Code:11554-1712
Mailing Address - Country:US
Mailing Address - Phone:516-794-0616
Mailing Address - Fax:516-794-2562
Practice Address - Street 1:1910 HEMPSTEAD TPKE
Practice Address - Street 2:
Practice Address - City:EAST MEADOW
Practice Address - State:NY
Practice Address - Zip Code:11554-1712
Practice Address - Country:US
Practice Address - Phone:516-794-0616
Practice Address - Fax:516-794-2562
Is Sole Proprietor?:Yes
Enumeration Date:2007-12-13
Last Update Date:2007-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY046523183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY01457345Medicaid