Provider Demographics
NPI:1679906374
Name:ROSE, RACHAEL MARIE (RPH)
Entity type:Individual
Prefix:DR
First Name:RACHAEL
Middle Name:MARIE
Last Name:ROSE
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 1:709 W UNION ST
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:NY
Mailing Address - Zip Code:14513-1357
Mailing Address - Country:US
Mailing Address - Phone:315-332-0193
Mailing Address - Fax:315-332-0197
Practice Address - Street 1:709 W UNION ST
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:NY
Practice Address - Zip Code:14513-1357
Practice Address - Country:US
Practice Address - Phone:315-332-0193
Practice Address - Fax:315-332-0197
Is Sole Proprietor?:No
Enumeration Date:2013-08-16
Last Update Date:2014-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY058204183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist