Provider Demographics
NPI:1588315246
Name:ROSEBLOCK, MICHELLE RENEE (PHARMD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:RENEE
Last Name:ROSEBLOCK
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18411 E HIGHLAND DR
Mailing Address - Street 2:
Mailing Address - City:PLEASANT HILL
Mailing Address - State:MO
Mailing Address - Zip Code:64080-7515
Mailing Address - Country:US
Mailing Address - Phone:816-674-3634
Mailing Address - Fax:
Practice Address - Street 1:4545 S NOLAND RD
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-4887
Practice Address - Country:US
Practice Address - Phone:816-478-1968
Practice Address - Fax:816-478-5649
Is Sole Proprietor?:Yes
Enumeration Date:2022-01-14
Last Update Date:2022-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009027315183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist