Provider Demographics
NPI:1952512402
Name:ROSE, JILL M (RPH)
Entity Type:Individual
Prefix:
First Name:JILL
Middle Name:M
Last Name:ROSE
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:675 GAR RD.
Mailing Address - Street 2:
Mailing Address - City:SMOAKS
Mailing Address - State:SC
Mailing Address - Zip Code:29481
Mailing Address - Country:US
Mailing Address - Phone:440-376-1025
Mailing Address - Fax:
Practice Address - Street 1:9912 DUNBARTON BLVD
Practice Address - Street 2:
Practice Address - City:BARNWELL
Practice Address - State:SC
Practice Address - Zip Code:29812-1442
Practice Address - Country:US
Practice Address - Phone:803-259-3649
Practice Address - Fax:803-259-7943
Is Sole Proprietor?:No
Enumeration Date:2007-05-25
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-16104183500000X
SC42478183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist