Healthcare Provider Details

I. General information

NPI: 1871980193
Provider Name (Legal Business Name): ALAN R ROSENTHAL RPH, PHARMD
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/24/2015
Last Update Date: 04/24/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6930 N BEECH TREE DR
MILWAUKEE WI
53209
US

IV. Provider business mailing address

6930 N BEECH TREE DR
MILWAUKEE WI
53209
US

V. Phone/Fax

Practice location:
  • Phone: 414-228-9540
  • Fax:
Mailing address:
  • Phone: 414-228-9540
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number13369-040
License Number StateWI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: