MEDICARE: MR. PHILIP JOE ROSE RPH

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	10782	OK

General Provider Information

NPI Number	:	1407450257
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILIP JOE ROSE RPH

Provider Business Mailing Address
First Line	:	4109 MOORGATE CIR
Second Line	:
City	:	NORMAN
State	:	OK
Zip	:	73072-9783
Country	:	US
Telephone Number	:	405-314-6074
Fax Number	:

Provider Business Practice Location Address
First Line	:	5401 TINKER DIAG ST
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-4622
Country	:	US
Telephone Number	:	405-670-1030
Fax Number	:	405-670-1036

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

Provider Enumeration Date	:	11/23/2020
Last Update Date	:	11/23/2020

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