Provider Demographics
NPI:1669081956
Name:ROSA, JOHN R (PHARMD)
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:R
Last Name:ROSA
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:255 NW VICTORIA DR STE B
Mailing Address - Street 2:
Mailing Address - City:LEES SUMMIT
Mailing Address - State:MO
Mailing Address - Zip Code:64086-4709
Mailing Address - Country:US
Mailing Address - Phone:855-937-7273
Mailing Address - Fax:844-878-6793
Practice Address - Street 1:255 NW VICTORIA DR STE B
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64086-4709
Practice Address - Country:US
Practice Address - Phone:855-937-7273
Practice Address - Fax:844-878-6793
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2021051192183500000X
KY023980183500000X
MI5302415724183500000X
KS1-109420183500000X
VA0202221730183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist