MEDICARE: DR. KEVIN DE JESUS ROSA 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	183500000X	Pharmacist	8337	PR

General Provider Information

NPI Number	:	1558167411
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KEVIN DE JESUS ROSA PHARMD

Provider Business Mailing Address
First Line	:	EXT VILLA RICA C ANA E5
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00959
Country	:	US
Telephone Number	:	787-599-7123
Fax Number	:

Provider Business Practice Location Address
First Line	:	1 CARR 862
Second Line	:
City	:	BAYAMON
State	:	PR
Zip	:	00959-4214
Country	:	US
Telephone Number	:	787-269-3140
Fax Number	:

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

Provider Enumeration Date	:	02/21/2025
Last Update Date	:	02/21/2025

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