Provider Demographics
NPI:1700980497
Name:ROSA, JOSE O (RPH)
Entity Type:Individual
Prefix:
First Name:JOSE
Middle Name:O
Last Name:ROSA
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:76 CALLE LUIS ORDONEZ
Mailing Address - Street 2:COUNTRY VIEW
Mailing Address - City:CANOVANAS
Mailing Address - State:PR
Mailing Address - Zip Code:00729-3107
Mailing Address - Country:US
Mailing Address - Phone:787-450-1039
Mailing Address - Fax:
Practice Address - Street 1:10 CASIA STREET (119)
Practice Address - Street 2:VA CARIBBEAN 119
Practice Address - City:SAN JUAN
Practice Address - State:PR
Practice Address - Zip Code:00921
Practice Address - Country:US
Practice Address - Phone:787-450-1039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PR4227183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist