Provider Demographics
NPI:1740527332
Name:PINKSTAFF, ROSE (RPH)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:
Last Name:PINKSTAFF
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1860 BARNETT SHOALS RD
Mailing Address - Street 2:
Mailing Address - City:ATHENS
Mailing Address - State:GA
Mailing Address - Zip Code:30605-6811
Mailing Address - Country:US
Mailing Address - Phone:706-227-6265
Mailing Address - Fax:706-227-6270
Practice Address - Street 1:1860 BARNETT SHOALS RD
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:GA
Practice Address - Zip Code:30605-6811
Practice Address - Country:US
Practice Address - Phone:706-227-6265
Practice Address - Fax:706-227-6270
Is Sole Proprietor?:Yes
Enumeration Date:2013-01-16
Last Update Date:2013-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12033183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist