Basic Information
| Provider Information | |||||||||
| NPI: | 1063916187 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | ROSE | ||||||||
| FirstName: | MICHAEL | ||||||||
| MiddleName: | |||||||||
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| Credential: | PHARMACIST, RPH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1009 NE 26TH AVE | ||||||||
| Address2: | |||||||||
| City: | HALLANDALE BEACH | ||||||||
| State: | FL | ||||||||
| PostalCode: | 330092950 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9548540707 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 3601 FEDERAL HWY | ||||||||
| Address2: | |||||||||
| City: | MIAMI | ||||||||
| State: | FL | ||||||||
| PostalCode: | 331373795 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7864761005 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/22/2018 | ||||||||
| LastUpdateDate: | 01/14/2020 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 01/14/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 183500000X | 20414 | FL | Y | Pharmacy Service Providers | Pharmacist |
No ID Information.