Provider Demographics
NPI:1699043521
Name:ROSE, JOHN JOSEPH JR (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:JOHN
Middle Name:JOSEPH
Last Name:ROSE
Suffix:JR
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1280 DANA DR
Mailing Address - Street 2:T-0615
Mailing Address - City:REDDING
Mailing Address - State:CA
Mailing Address - Zip Code:96003-4038
Mailing Address - Country:US
Mailing Address - Phone:530-224-1437
Mailing Address - Fax:530-224-1437
Practice Address - Street 1:1280 DANA DR
Practice Address - Street 2:T-0615
Practice Address - City:REDDING
Practice Address - State:CA
Practice Address - Zip Code:96003-4038
Practice Address - Country:US
Practice Address - Phone:530-224-1437
Practice Address - Fax:530-224-1437
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-06
Last Update Date:2011-12-06
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CA66667183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist