Provider Demographics
NPI:1588982102
Name:DEROIA, ROSE ANNE (BS)
Entity type:Individual
Prefix:MRS
First Name:ROSE
Middle Name:ANNE
Last Name:DEROIA
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 GREENVIEW DR
Mailing Address - Street 2:
Mailing Address - City:AURORA
Mailing Address - State:OH
Mailing Address - Zip Code:44202-7901
Mailing Address - Country:US
Mailing Address - Phone:330-995-0766
Mailing Address - Fax:
Practice Address - Street 1:1750 HIGHLAND RD
Practice Address - Street 2:STE 1
Practice Address - City:TWINSBURG
Practice Address - State:OH
Practice Address - Zip Code:44087-2275
Practice Address - Country:US
Practice Address - Phone:800-533-7114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-06
Last Update Date:2010-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03315593183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist