Healthcare Provider Details

I. General information

NPI: 1669980405
Provider Name (Legal Business Name): MARCY E ROSEN RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 06/16/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1520 N MAIN STREET EXT
BUTLER PA
16001-1546
US

IV. Provider business mailing address

209 CEDAR RD
BUTLER PA
16001-2151
US

V. Phone/Fax

Practice location:
  • Phone: 724-282-8113
  • Fax:
Mailing address:
  • Phone: 724-355-8262
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP038295L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: