Provider Demographics
NPI:1750667374
Name:LARUSSA CONKEL, ROSEMARY (RPH)
Entity Type:Individual
Prefix:MS
First Name:ROSEMARY
Middle Name:
Last Name:LARUSSA CONKEL
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:ROSEMARY
Other - Middle Name:
Other - Last Name:LARUSSA GOMEZ
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15363 77TH PL N
Mailing Address - Street 2:
Mailing Address - City:LOXAHATCHEE
Mailing Address - State:FL
Mailing Address - Zip Code:33470-3159
Mailing Address - Country:US
Mailing Address - Phone:561-792-1362
Mailing Address - Fax:
Practice Address - Street 1:15940 ORANGE BLVD
Practice Address - Street 2:
Practice Address - City:LOXAHATCHEE
Practice Address - State:FL
Practice Address - Zip Code:33470-3442
Practice Address - Country:US
Practice Address - Phone:561-899-1379
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-27
Last Update Date:2021-07-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS23701183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist