Provider Demographics
NPI:1992833867
Name:ROSE BROS INC
Entity Type:Organization
Organization Name:ROSE BROS INC
Other - Org Name:MEDWISE PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:SAJI
Authorized Official - Middle Name:
Authorized Official - Last Name:SAMUEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:954-472-7244
Mailing Address - Street 1:100 NW 82ND AVE
Mailing Address - Street 2:SUITE 406
Mailing Address - City:PLANTATION
Mailing Address - State:FL
Mailing Address - Zip Code:33324-7809
Mailing Address - Country:US
Mailing Address - Phone:954-472-7244
Mailing Address - Fax:954-472-7278
Practice Address - Street 1:100 NW 82ND AVE STE 406
Practice Address - Street 2:
Practice Address - City:PLANTATION
Practice Address - State:FL
Practice Address - Zip Code:33324-1835
Practice Address - Country:US
Practice Address - Phone:954-472-7244
Practice Address - Fax:954-472-7278
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ROSE BROS INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-03-01
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X
FLPH70153336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No333600000XSuppliersPharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLPH 7015OtherPHARMACY LICENSE
FLAR7986411OtherDEA NUMBER
FLPH 7015OtherPHARMACY LICENSE