Provider Demographics
NPI:1396394177
Name:ROSE, KARRIE ANN (RPH)
Entity type:Individual
Prefix:MRS
First Name:KARRIE
Middle Name:ANN
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 1:9008 SEA WIND PL
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46804-4820
Mailing Address - Country:US
Mailing Address - Phone:260-241-1268
Mailing Address - Fax:
Practice Address - Street 1:1710 APPLE GLEN BLVD
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46804-1725
Practice Address - Country:US
Practice Address - Phone:260-432-9330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-05
Last Update Date:2019-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26016399A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist