Provider Demographics
NPI:1942947460
Name:NMMB ENTERPRISE LLC
Entity Type:Organization
Organization Name:NMMB ENTERPRISE LLC
Other - Org Name:ROSE PHARMACY AND BOUTIQUE APOTHECARY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PHARMACIST/ OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:ROSEBOROUGH
Authorized Official - Last Name:EASTMAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHARM D
Authorized Official - Phone:704-255-6172
Mailing Address - Street 1:19701 BETHEL CHURCH RD STE 103-215
Mailing Address - Street 2:
Mailing Address - City:CORNELIUS
Mailing Address - State:NC
Mailing Address - Zip Code:28031-4072
Mailing Address - Country:US
Mailing Address - Phone:704-578-4360
Mailing Address - Fax:
Practice Address - Street 1:20035 JETTON RD STE B
Practice Address - Street 2:
Practice Address - City:CORNELIUS
Practice Address - State:NC
Practice Address - Zip Code:28031-8277
Practice Address - Country:US
Practice Address - Phone:704-255-6172
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-16
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy