Provider Demographics
NPI:1841775392
Name:ROSE PHARMACY RM LLC
Entity Type:Organization
Organization Name:ROSE PHARMACY RM LLC
Other - Org Name:ROSE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:SENIOR DIRECTOR OF OPERATIONS
Authorized Official - Prefix:MR
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUTLER
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:630-242-8969
Mailing Address - Street 1:35400 BOB HOPE DRIVE
Mailing Address - Street 2:SUITE #207
Mailing Address - City:RANCHO MIRAGE
Mailing Address - State:CA
Mailing Address - Zip Code:92270
Mailing Address - Country:US
Mailing Address - Phone:760-832-6287
Mailing Address - Fax:760-832-6271
Practice Address - Street 1:35400 BOB HOPE DRIVE
Practice Address - Street 2:SUITE #207
Practice Address - City:RANCHO MIRAGE
Practice Address - State:CA
Practice Address - Zip Code:92270
Practice Address - Country:US
Practice Address - Phone:760-832-6287
Practice Address - Fax:760-832-6271
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIORX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2018-10-01
Last Update Date:2024-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
7853430001OtherMEDICARE PTAN
CA1841775392Medicaid
CAPHY57776OtherCA BOARD OF PHARMACY LICENSE