MEDICARE: MR. GARY ALLAN ROSEMAN R.PH.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	IA-15548	IA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1033285895
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. GARY ALLAN ROSEMAN R.PH.

Provider Business Mailing Address
First Line	:	PO BOX 42311
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50323-0985
Country	:	US
Telephone Number	:	515-727-5689
Fax Number	:	515-727-5689

Provider Business Practice Location Address
First Line	:	3998 NW URBANDALE DR
Second Line	:
City	:	URBANDALE
State	:	IA
Zip	:	50322-7922
Country	:	US
Telephone Number	:	515-278-0117
Fax Number	:	515-278-6165

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/24/2006
Last Update Date	:	07/09/2007

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