Provider Demographics
NPI:1316610637
Name:ROSE, BRIAN JAMES (PHARM D)
Entity type:Individual
Prefix:
First Name:BRIAN
Middle Name:JAMES
Last Name:ROSE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 SW WILLISTON RD APT 1321
Mailing Address - Street 2:
Mailing Address - City:GAINESVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32608-3951
Mailing Address - Country:US
Mailing Address - Phone:352-410-4864
Mailing Address - Fax:
Practice Address - Street 1:5200 SW 34TH ST
Practice Address - Street 2:
Practice Address - City:GAINESVILLE
Practice Address - State:FL
Practice Address - Zip Code:32608-5010
Practice Address - Country:US
Practice Address - Phone:352-375-1496
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-02
Last Update Date:2021-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS62746183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist