Provider Demographics
NPI:1306122668
Name:ROSENTHAL, PHILIP STEVEN (RPH)
Entity type:Individual
Prefix:
First Name:PHILIP
Middle Name:STEVEN
Last Name:ROSENTHAL
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2283 OTTER ROCK AVE
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89044
Mailing Address - Country:US
Mailing Address - Phone:702-458-6012
Mailing Address - Fax:
Practice Address - Street 1:11001 S EASTERN AVE
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89052-2954
Practice Address - Country:US
Practice Address - Phone:702-948-8355
Practice Address - Fax:702-948-8352
Is Sole Proprietor?:No
Enumeration Date:2011-10-31
Last Update Date:2011-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV16864183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist