Provider Demographics
NPI:1053435255
Name:ROSA, SANDRA W (RPH)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:W
Last Name:ROSA
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 E ALBURG RD
Mailing Address - Street 2:
Mailing Address - City:ALBURGH
Mailing Address - State:VT
Mailing Address - Zip Code:05440-4006
Mailing Address - Country:US
Mailing Address - Phone:802-796-3566
Mailing Address - Fax:802-654-0706
Practice Address - Street 1:261 MOUNTAIN VIEW DR
Practice Address - Street 2:
Practice Address - City:COLCHESTER
Practice Address - State:VT
Practice Address - Zip Code:05446-5823
Practice Address - Country:US
Practice Address - Phone:802-735-2639
Practice Address - Fax:802-654-0706
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2013-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
RI2243183500000X
NYI-054517-1183500000X
VT033.0046703183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist