Healthcare Provider Details

I. General information

NPI: 1467738054
Provider Name (Legal Business Name): PHILLIP JAMES ROSE R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3104 DIXIE HWY
ERLANGER KY
41018-1827
US

IV. Provider business mailing address

3104 DIXIE HWY
ERLANGER KY
41018-1827
US

V. Phone/Fax

Practice location:
  • Phone: 859-426-0342
  • Fax: 859-426-0379
Mailing address:
  • Phone: 859-426-0342
  • Fax: 859-426-0379

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number010817
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: