Provider Demographics
NPI:1750628509
Name:ROSEMARIN, STACY MERYL (RPH)
Entity Type:Individual
Prefix:MS
First Name:STACY
Middle Name:MERYL
Last Name:ROSEMARIN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19470 WATERS REACH LN
Mailing Address - Street 2:703
Mailing Address - City:BOCA RATON
Mailing Address - State:FL
Mailing Address - Zip Code:33434-5116
Mailing Address - Country:US
Mailing Address - Phone:561-483-0672
Mailing Address - Fax:
Practice Address - Street 1:19470 WATERS REACH LN
Practice Address - Street 2:703
Practice Address - City:BOCA RATON
Practice Address - State:FL
Practice Address - Zip Code:33434-5116
Practice Address - Country:US
Practice Address - Phone:561-483-0672
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-14
Last Update Date:2013-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS24143183500000X
NJ28RI01818200183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist