Provider Demographics
NPI:1770604837
Name:ROSE, S. RUTHERFOORD (PHARMD)
Entity type:Individual
Prefix:DR
First Name:S.
Middle Name:RUTHERFOORD
Last Name:ROSE
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 WADEWARD RD
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:VA
Mailing Address - Zip Code:23229-7136
Mailing Address - Country:US
Mailing Address - Phone:804-740-5406
Mailing Address - Fax:
Practice Address - Street 1:1201 EAST MARSHALL STREET
Practice Address - Street 2:EMERGENCY MEDICINE
Practice Address - City:RICHMOND
Practice Address - State:VA
Practice Address - Zip Code:23298
Practice Address - Country:US
Practice Address - Phone:804-828-4780
Practice Address - Fax:804-828-5291
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0202006913183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist