Provider Demographics
NPI:1659675213
Name:MUSE, ROSLYN FAY
Entity Type:Individual
Prefix:MS
First Name:ROSLYN
Middle Name:FAY
Last Name:MUSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3825 S ROXBORO ST STE 101
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-4700
Mailing Address - Country:US
Mailing Address - Phone:919-361-0629
Mailing Address - Fax:919-484-4045
Practice Address - Street 1:3825 S ROXBORO ST STE 101
Practice Address - Street 2:
Practice Address - City:DURHAM
Practice Address - State:NC
Practice Address - Zip Code:27713-4700
Practice Address - Country:US
Practice Address - Phone:919-361-0629
Practice Address - Fax:919-484-4045
Is Sole Proprietor?:No
Enumeration Date:2010-12-22
Last Update Date:2010-12-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC7361183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0326587Medicaid
NC0326587Medicaid