Healthcare Provider Details

I. General information

NPI: 1154319572
Provider Name (Legal Business Name): ROSAUERS SUPERMARKETS INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/10/2005
Last Update Date: 09/13/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1250 N HIGHWAY 395
COLVILLE WA
99114-2005
US

IV. Provider business mailing address

PO BOX 9000 1815 W GARLAND
SPOKANE WA
99209-9000
US

V. Phone/Fax

Practice location:
  • Phone: 509-684-3151
  • Fax: 509-684-3233
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberCF56023
License Number StateWA

VIII. Authorized Official

Name: JEFFRY PHILIPPS
Title or Position: PRES
Credential: RPH
Phone: 509-326-8900