Provider Demographics
NPI:1679856231
Name:BARNES, ROSE ALTA (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROSE
Middle Name:ALTA
Last Name:BARNES
Suffix:
Gender:F
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4309 NORWICK DR
Mailing Address - Street 2:
Mailing Address - City:FAYETTEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28314-2531
Mailing Address - Country:US
Mailing Address - Phone:910-483-9999
Mailing Address - Fax:
Practice Address - Street 1:3300 RAMSEY ST
Practice Address - Street 2:
Practice Address - City:FAYETTEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28301-7624
Practice Address - Country:US
Practice Address - Phone:910-822-4965
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-21
Last Update Date:2011-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC161031835P1200X
TX311631835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy