Healthcare Provider Details

I. General information

NPI: 1891847166
Provider Name (Legal Business Name): JOSEPH MICHAEL ROSENTHAL R.PH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1328 E EVERGREEN ST
SPRINGFIELD MO
65803-4400
US

IV. Provider business mailing address

1440 STATE HIGHWAY 248 STE Q-444
BRANSON MO
65616-9655
US

V. Phone/Fax

Practice location:
  • Phone: 417-889-6357
  • Fax: 417-823-3870
Mailing address:
  • Phone: 417-561-4087
  • Fax: 417-332-0793

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number030058
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: