Healthcare Provider Details

I. General information

NPI: 1558405217
Provider Name (Legal Business Name): ROOS PHARMACY NORTH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/16/2007
Last Update Date: 05/22/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2370 GREENWOOD RD
PRESCOTT MI
48756-9655
US

IV. Provider business mailing address

2370 GREENWOOD RD P.O. BOX 4033
PRESCOTT MI
48756-9655
US

V. Phone/Fax

Practice location:
  • Phone: 989-873-1478
  • Fax: 989-873-1475
Mailing address:
  • Phone: 989-873-1478
  • Fax: 989-873-1475

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number5301003126
License Number StateMI

VIII. Authorized Official

Name: MR. EDWARD ROOS
Title or Position: PRESIDENT PHARMACIST
Credential: RPH.
Phone: 989-873-1478