MEDICARE: DR. KESHIA ROSE PHARMD

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	1835P0018X	Pharmacist Clinician (PhC)/ Clinical Pharmacy Specialist	0202212994	VA

General Provider Information

NPI Number	:	1508497835
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KESHIA ROSE PHARMD

Provider Business Mailing Address
First Line	:	1401 N MAIN ST
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4352
Country	:	US
Telephone Number	:	757-539-4834
Fax Number	:	757-539-2076

Provider Business Practice Location Address
First Line	:	1401 N MAIN ST
Second Line	:
City	:	SUFFOLK
State	:	VA
Zip	:	23434-4352
Country	:	US
Telephone Number	:	757-539-4834
Fax Number	:	757-539-2076

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

Provider Enumeration Date	:	01/27/2020
Last Update Date	:	01/27/2020

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