Provider Demographics
NPI:1841227154
Name:ROSENBLATT, BURTON KENNETH (RPH)
Entity Type:Individual
Prefix:MR
First Name:BURTON
Middle Name:KENNETH
Last Name:ROSENBLATT
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11090 SW CHICKADEE TER
Mailing Address - Street 2:
Mailing Address - City:BEAVERTON
Mailing Address - State:OR
Mailing Address - Zip Code:97007-8175
Mailing Address - Country:US
Mailing Address - Phone:503-220-8262
Mailing Address - Fax:360-905-1776
Practice Address - Street 1:US VETERANS HOSPITAL ROAD
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97207
Practice Address - Country:US
Practice Address - Phone:503-220-8262
Practice Address - Fax:360-905-1776
Is Sole Proprietor?:No
Enumeration Date:2006-06-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6739183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist