Provider Demographics
NPI:1477206464
Name:HINES, ROSEANN RICHARDS (PHARMD)
Entity type:Individual
Prefix:
First Name:ROSEANN
Middle Name:RICHARDS
Last Name:HINES
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:ROSEANN
Other - Middle Name:MARIE
Other - Last Name:RICHARDS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2022 COLUMBUS AVE
Mailing Address - Street 2:
Mailing Address - City:DULUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55803-2425
Mailing Address - Country:US
Mailing Address - Phone:920-227-5784
Mailing Address - Fax:
Practice Address - Street 1:204 BELKNAP ST
Practice Address - Street 2:
Practice Address - City:SUPERIOR
Practice Address - State:WI
Practice Address - Zip Code:54880-2900
Practice Address - Country:US
Practice Address - Phone:218-576-0853
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-31
Last Update Date:2022-01-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN122127333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy