Provider Demographics
NPI:1851684799
Name:ROSE, RICHARD JAMES (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:JAMES
Last Name:ROSE
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:PO BOX 23394
Mailing Address - Street 2:
Mailing Address - City:TIGARD
Mailing Address - State:OR
Mailing Address - Zip Code:97281-3394
Mailing Address - Country:US
Mailing Address - Phone:503-620-0970
Mailing Address - Fax:
Practice Address - Street 1:7645 SW BOND ST
Practice Address - Street 2:
Practice Address - City:TIGARD
Practice Address - State:OR
Practice Address - Zip Code:97224-7955
Practice Address - Country:US
Practice Address - Phone:503-620-0970
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR6620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist