Provider Demographics
NPI:1215026711
Name:ROSE PHARMACY SA, LLC
Entity type:Organization
Organization Name:ROSE PHARMACY SA, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-242-8969
Mailing Address - Street 1:1220 W HEMLOCK WAY
Mailing Address - Street 2:STE #110
Mailing Address - City:SANTA ANA
Mailing Address - State:CA
Mailing Address - Zip Code:92707
Mailing Address - Country:US
Mailing Address - Phone:714-662-0548
Mailing Address - Fax:714-662-0549
Practice Address - Street 1:1220 W HEMLOCK WAY
Practice Address - Street 2:STE #110
Practice Address - City:SANTA ANA
Practice Address - State:CA
Practice Address - Zip Code:92707
Practice Address - Country:US
Practice Address - Phone:714-662-0548
Practice Address - Fax:714-662-0549
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIORX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2006-10-12
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes3336C0003XSuppliersPharmacyCommunity/Retail PharmacyGroup - Single Specialty
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No333600000XSuppliersPharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
5659140001OtherMEDICARE
N-6PJ14HOtherHQAA
CA1215026711Medicaid
CA57774OtherCA BOARD OF PHARMACY