Healthcare Provider Details

I. General information

NPI: 1487869731
Provider Name (Legal Business Name): BARRY LIVINGSTON ROSE RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4644 HIGHWAY 15 WEST
CLAY CITY KY
40312
US

IV. Provider business mailing address

499 ROSE LANE
CLAY CITY KY
40312
US

V. Phone/Fax

Practice location:
  • Phone: 606-663-3481
  • Fax: 606-663-4235
Mailing address:
  • Phone: 606-663-1471
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010655
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: