Provider Demographics
NPI:1427338359
Name:ROSE PHARMACY SF, LLC
Entity type:Organization
Organization Name:ROSE PHARMACY SF, LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CFO
Authorized Official - Prefix:
Authorized Official - First Name:LEO
Authorized Official - Middle Name:
Authorized Official - Last Name:LAFRANCO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:630-242-8969
Mailing Address - Street 1:12540 MCCANN DRIVE
Mailing Address - Street 2:
Mailing Address - City:SANTA FE SPRINGS
Mailing Address - State:CA
Mailing Address - Zip Code:90670
Mailing Address - Country:US
Mailing Address - Phone:714-664-0518
Mailing Address - Fax:714-664-0680
Practice Address - Street 1:12540 MCCANN DRIVE
Practice Address - Street 2:
Practice Address - City:SANTA FE SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:90670
Practice Address - Country:US
Practice Address - Phone:714-664-0518
Practice Address - Fax:714-664-0680
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIORX, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-08-23
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336L0003XSuppliersPharmacyLong Term Care Pharmacy
No3336C0004XSuppliersPharmacyCompounding Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA57775OtherCA BOARD OF PHARMACY
7683430001OtherMEDICARE PTAN
CA1427338359Medicaid