Provider Demographics
NPI:1851068860
Name:ROSA, ADDYSON (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:ADDYSON
Middle Name:
Last Name:ROSA
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 1:501 NE 7TH ST
Mailing Address - Street 2:
Mailing Address - City:GRIMES
Mailing Address - State:IA
Mailing Address - Zip Code:50111-2204
Mailing Address - Country:US
Mailing Address - Phone:515-423-4069
Mailing Address - Fax:
Practice Address - Street 1:2150 E 1ST ST
Practice Address - Street 2:
Practice Address - City:GRIMES
Practice Address - State:IA
Practice Address - Zip Code:50111-7606
Practice Address - Country:US
Practice Address - Phone:515-986-3657
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-26
Last Update Date:2021-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA24252183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist