Provider Demographics
NPI:1366988321
Name:ROSE, WILLIAM CARROLL JR (RPH)
Entity type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:CARROLL
Last Name:ROSE
Suffix:JR
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 1:303 NASH ST W
Mailing Address - Street 2:
Mailing Address - City:WILSON
Mailing Address - State:NC
Mailing Address - Zip Code:27893-3834
Mailing Address - Country:US
Mailing Address - Phone:252-237-1188
Mailing Address - Fax:252-206-1990
Practice Address - Street 1:303 NASH ST W
Practice Address - Street 2:
Practice Address - City:WILSON
Practice Address - State:NC
Practice Address - Zip Code:27893-3834
Practice Address - Country:US
Practice Address - Phone:252-237-1188
Practice Address - Fax:252-206-1990
Is Sole Proprietor?:No
Enumeration Date:2017-01-16
Last Update Date:2017-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC08924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC08924OtherNC BOARD OF PHARMACY