Healthcare Provider Details

I. General information

NPI: 1154901932
Provider Name (Legal Business Name): MAEGAN S ROSE PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/14/2021
Last Update Date: 04/14/2021
Certification Date: 04/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1545 AIRPORT BLVD
PENSACOLA FL
32504-8615
US

IV. Provider business mailing address

1545 AIRPORT BLVD
PENSACOLA FL
32504-8615
US

V. Phone/Fax

Practice location:
  • Phone: 850-416-2679
  • Fax:
Mailing address:
  • Phone: 850-416-2679
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License NumberPS46589
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: