Provider Demographics
NPI:1659972305
Name:SNOW, ROSEMARY JEAN
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:JEAN
Last Name:SNOW
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 1:7981 KILLEEN ST NW
Mailing Address - Street 2:
Mailing Address - City:MASSILLON
Mailing Address - State:OH
Mailing Address - Zip Code:44646-9522
Mailing Address - Country:US
Mailing Address - Phone:330-904-1624
Mailing Address - Fax:
Practice Address - Street 1:5841 W 130TH ST
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44130-9308
Practice Address - Country:US
Practice Address - Phone:216-265-7700
Practice Address - Fax:216-265-7744
Is Sole Proprietor?:No
Enumeration Date:2020-11-07
Last Update Date:2020-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03219557183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH03-2-19557Medicaid