Provider Demographics
NPI:1306434295
Name:ROSEKRANS, NATASHA LYNN
Entity type:Individual
Prefix:
First Name:NATASHA
Middle Name:LYNN
Last Name:ROSEKRANS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17 E HARRIS DR
Mailing Address - Street 2:
Mailing Address - City:FORT RUCKER
Mailing Address - State:AL
Mailing Address - Zip Code:36362-2305
Mailing Address - Country:US
Mailing Address - Phone:334-389-3143
Mailing Address - Fax:
Practice Address - Street 1:850 BOLL WEEVIL CIR
Practice Address - Street 2:
Practice Address - City:ENTERPRISE
Practice Address - State:AL
Practice Address - Zip Code:36330-2080
Practice Address - Country:US
Practice Address - Phone:334-389-3143
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-01-06
Last Update Date:2021-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL21003183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist