Provider Demographics
NPI:1740278175
Name:ROSAUERS SUPERMARKETS INC
Entity type:Organization
Organization Name:ROSAUERS SUPERMARKETS INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRES
Authorized Official - Prefix:
Authorized Official - First Name:JEFFRY
Authorized Official - Middle Name:
Authorized Official - Last Name:PHILIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:509-326-8900
Mailing Address - Street 1:W 1808 THIRD AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99204-0710
Mailing Address - Country:US
Mailing Address - Phone:509-624-0126
Mailing Address - Fax:
Practice Address - Street 1:1808 W 3RD AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99204-0710
Practice Address - Country:US
Practice Address - Phone:509-838-3618
Practice Address - Fax:509-456-2358
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-10
Last Update Date:2008-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
WA2620104038423336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA6181507Medicaid
4910685OtherOTHER ID NUMBER
0636370013Medicare NSC