Healthcare Provider Details

I. General information

NPI: 1093038036
Provider Name (Legal Business Name): ALAN S ROSENBLUM RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/04/2010
Last Update Date: 03/04/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

392 FEURA BUSH RD
GLENMONT NY
12077-2954
US

IV. Provider business mailing address

161 JORDAN BLVD
DELMAR NY
12054-4132
US

V. Phone/Fax

Practice location:
  • Phone: 518-462-5507
  • Fax:
Mailing address:
  • Phone: 518-439-4999
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number047588
License Number StateNY
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number23250
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: