Healthcare Provider Details

I. General information

NPI: 1457581316
Provider Name (Legal Business Name): MICHAEL LAWRENCE ROSE PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/24/2009
Last Update Date: 07/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1901 VETERANS MEMORIAL DR
TEMPLE TX
76504-7451
US

IV. Provider business mailing address

3118A NORTHWEST BLVD
GEORGETOWN TX
78628-4225
US

V. Phone/Fax

Practice location:
  • Phone: 254-743-2943
  • Fax:
Mailing address:
  • Phone: 817-690-5081
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number47331
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: