Provider Demographics
NPI:1740490721
Name:ROSKA, MARK P (RPH)
Entity type:Individual
Prefix:MR
First Name:MARK
Middle Name:P
Last Name:ROSKA
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 1:28094 SW MORGAN ST
Mailing Address - Street 2:
Mailing Address - City:WILSONVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97070-6791
Mailing Address - Country:US
Mailing Address - Phone:503-682-3862
Mailing Address - Fax:
Practice Address - Street 1:438 E BURNSIDE ST
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-1108
Practice Address - Country:US
Practice Address - Phone:503-281-4161
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR0009142183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist