Provider Demographics
NPI:1740270958
Name:ROSKA, ELLEN (PHARM D)
Entity type:Individual
Prefix:
First Name:ELLEN
Middle Name:
Last Name:ROSKA
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2050 2ND ST SE
Mailing Address - Street 2:
Mailing Address - City:KIRTLAND AFB
Mailing Address - State:NM
Mailing Address - Zip Code:87117-5524
Mailing Address - Country:US
Mailing Address - Phone:505-846-3639
Mailing Address - Fax:505-846-3137
Practice Address - Street 1:2050 2ND ST SE
Practice Address - Street 2:
Practice Address - City:KIRTLAND AFB
Practice Address - State:NM
Practice Address - Zip Code:87117-5524
Practice Address - Country:US
Practice Address - Phone:505-846-3639
Practice Address - Fax:505-846-3137
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-10-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA201091835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy