Provider Demographics
NPI:1750700381
Name:ROSENBERG, NAOMI WENDY (RPH)
Entity type:Individual
Prefix:
First Name:NAOMI
Middle Name:WENDY
Last Name:ROSENBERG
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 1:1280 GAIL GARDNER WAY
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86305-1641
Mailing Address - Country:US
Mailing Address - Phone:928-541-0562
Mailing Address - Fax:928-541-0584
Practice Address - Street 1:1280 GAIL GARDNER WAY
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86305-1641
Practice Address - Country:US
Practice Address - Phone:928-541-0562
Practice Address - Fax:928-541-0584
Is Sole Proprietor?:No
Enumeration Date:2014-04-10
Last Update Date:2014-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS008742183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZS008742OtherPHARMACIST LICENSE NUMBER