Provider Demographics
NPI:1316650492
Name:ROSADO, MARIO ANDRES (PHARMD)
Entity type:Individual
Prefix:
First Name:MARIO
Middle Name:ANDRES
Last Name:ROSADO
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9216 MAGNOLIA WAY
Mailing Address - Street 2:
Mailing Address - City:WINDSOR
Mailing Address - State:CA
Mailing Address - Zip Code:95492-8365
Mailing Address - Country:US
Mailing Address - Phone:863-840-2374
Mailing Address - Fax:
Practice Address - Street 1:9216 MAGNOLIA WAY
Practice Address - Street 2:
Practice Address - City:WINDSOR
Practice Address - State:CA
Practice Address - Zip Code:95492-8365
Practice Address - Country:US
Practice Address - Phone:863-840-2374
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-03
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018632183500000X
CA87656183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist