Provider Demographics
NPI:1801067038
Name:ROSTA, MICHAEL DOUGLAS (PHARMACIST)
Entity type:Individual
Prefix:MR
First Name:MICHAEL
Middle Name:DOUGLAS
Last Name:ROSTA
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:56 VERA ST
Mailing Address - Street 2:
Mailing Address - City:PISCATAWAY
Mailing Address - State:NJ
Mailing Address - Zip Code:08854-2535
Mailing Address - Country:US
Mailing Address - Phone:732-752-8932
Mailing Address - Fax:
Practice Address - Street 1:325 HIGHWAY 35
Practice Address - Street 2:
Practice Address - City:CLIFFWOOD
Practice Address - State:NJ
Practice Address - Zip Code:07721-1177
Practice Address - Country:US
Practice Address - Phone:732-441-9100
Practice Address - Fax:732-441-7454
Is Sole Proprietor?:No
Enumeration Date:2008-03-15
Last Update Date:2008-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA15770183500000X
OH03-2-26518183500000X
NJ28RI01378700183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist