Provider Demographics
NPI:1891847166
Name:ROSENTHAL, JOSEPH MICHAEL (RPH)
Entity Type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MICHAEL
Last Name:ROSENTHAL
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 1:1440 STATE HIGHWAY 248
Mailing Address - Street 2:STE Q-444
Mailing Address - City:BRANSON
Mailing Address - State:MO
Mailing Address - Zip Code:65616-9655
Mailing Address - Country:US
Mailing Address - Phone:417-561-4087
Mailing Address - Fax:417-332-0793
Practice Address - Street 1:1328 E EVERGREEN ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65803-4400
Practice Address - Country:US
Practice Address - Phone:417-889-6357
Practice Address - Fax:417-823-3870
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-17
Last Update Date:2010-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO030058183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist