Healthcare Provider Details

I. General information

NPI: 1033706064
Provider Name (Legal Business Name): JEFFREY A ROSEN RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/23/2020
Last Update Date: 12/23/2020
Certification Date: 12/23/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 WEST RD STE 100
TOWSON MD
21204-2321
US

IV. Provider business mailing address

32 WEST RD STE 100
TOWSON MD
21204-2321
US

V. Phone/Fax

Practice location:
  • Phone: 410-823-1818
  • Fax: 410-823-1888
Mailing address:
  • Phone: 410-823-1818
  • Fax: 410-823-1888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number9174
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number9174
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: