Provider Demographics
NPI:1457953457
Name:ROSSOW, ROBERT T (RPH)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:T
Last Name:ROSSOW
Suffix:
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 1:4902 CLIO RD
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48504-1898
Mailing Address - Country:US
Mailing Address - Phone:810-789-7084
Mailing Address - Fax:810-789-7088
Practice Address - Street 1:4902 CLIO RD
Practice Address - Street 2:
Practice Address - City:FLINT
Practice Address - State:MI
Practice Address - Zip Code:48504-1898
Practice Address - Country:US
Practice Address - Phone:810-789-7084
Practice Address - Fax:810-789-7088
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302028750183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist