Healthcare Provider Details

I. General information

NPI: 1205457199
Provider Name (Legal Business Name): ROTA HEALTH CENTER PHARMACY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/01/2020
Last Update Date: 05/01/2020
Certification Date: 05/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

SONGSONG VILLAGE
ROTA MP
96951
US

IV. Provider business mailing address

PO BOX 500409
SAIPAN MP
96950-0409
US

V. Phone/Fax

Practice location:
  • Phone: 670-532-9461
  • Fax:
Mailing address:
  • Phone: 670-236-8201
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: ESTHER L MUNA
Title or Position: CEO
Credential:
Phone: 670-236-8201