Provider Demographics
NPI:1679179998
Name:SEARLES, ROSANNA
Entity Type:Individual
Prefix:
First Name:ROSANNA
Middle Name:
Last Name:SEARLES
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 1:435 ELIZABETH AVE
Mailing Address - Street 2:
Mailing Address - City:SOMERSET
Mailing Address - State:NJ
Mailing Address - Zip Code:08873-1292
Mailing Address - Country:US
Mailing Address - Phone:732-469-4031
Mailing Address - Fax:
Practice Address - Street 1:435 ELIZABETH AVE
Practice Address - Street 2:
Practice Address - City:SOMERSET
Practice Address - State:NJ
Practice Address - Zip Code:08873-1292
Practice Address - Country:US
Practice Address - Phone:732-469-4031
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-10
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI01760500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist