Provider Demographics
NPI:1790381887
Name:KAVISHE, ROSEMARY THADDEUS (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSEMARY
Middle Name:THADDEUS
Last Name:KAVISHE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1853 W 2ND ST
Mailing Address - Street 2:
Mailing Address - City:FREEPORT
Mailing Address - State:TX
Mailing Address - Zip Code:77541-4613
Mailing Address - Country:US
Mailing Address - Phone:979-233-5415
Mailing Address - Fax:979-233-0298
Practice Address - Street 1:1853 W 2ND ST
Practice Address - Street 2:
Practice Address - City:FREEPORT
Practice Address - State:TX
Practice Address - Zip Code:77541-4613
Practice Address - Country:US
Practice Address - Phone:979-233-5415
Practice Address - Fax:979-233-0298
Is Sole Proprietor?:No
Enumeration Date:2020-12-05
Last Update Date:2020-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX47681183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist