Provider Demographics
NPI:1821061995
Name:ROSIN, RICHARD W (RPH MBA)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:W
Last Name:ROSIN
Suffix:
Gender:M
Credentials:RPH MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 AURORA DR
Mailing Address - Street 2:
Mailing Address - City:GREENBAY
Mailing Address - State:WI
Mailing Address - Zip Code:54302
Mailing Address - Country:US
Mailing Address - Phone:920-468-3448
Mailing Address - Fax:
Practice Address - Street 1:555 QUALITY CT
Practice Address - Street 2:
Practice Address - City:WRIGHTSTOWN
Practice Address - State:WI
Practice Address - Zip Code:54180
Practice Address - Country:US
Practice Address - Phone:920-532-0700
Practice Address - Fax:920-532-0728
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI8997040183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI33272700Medicaid
WI33272700Medicaid