Provider Demographics
NPI:1265556187
Name:HINES, ROSA A (RPH)
Entity type:Individual
Prefix:MS
First Name:ROSA
Middle Name:A
Last Name:HINES
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 1:174 MELROSE CREEK DR
Mailing Address - Street 2:
Mailing Address - City:STOCKBRIDGE
Mailing Address - State:GA
Mailing Address - Zip Code:30281-2333
Mailing Address - Country:US
Mailing Address - Phone:678-583-6560
Mailing Address - Fax:
Practice Address - Street 1:174 MELROSE CREEK DR
Practice Address - Street 2:
Practice Address - City:STOCKBRIDGE
Practice Address - State:GA
Practice Address - Zip Code:30281-2333
Practice Address - Country:US
Practice Address - Phone:678-583-6560
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARPH018069183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist