Healthcare Provider Details

I. General information

NPI: 1982937462
Provider Name (Legal Business Name): KARLA ROSENAU R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/15/2009
Last Update Date: 09/15/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2400 32ND AVE S SOUTHPOINTE PHARMACY
FARGO ND
58103-5800
US

IV. Provider business mailing address

1819 BRENTWOOD CT
WEST FARGO ND
58078-4204
US

V. Phone/Fax

Practice location:
  • Phone: 701-234-9912
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number4407
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: