Provider Demographics
NPI:1174807887
Name:ROSSER, ROBERT MILLER
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:MILLER
Last Name:ROSSER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:ROBERT
Other - Middle Name:MILLER
Other - Last Name:ROSSER
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMACIST
Mailing Address - Street 1:200 ROSSER BLVD
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35956-2851
Mailing Address - Country:US
Mailing Address - Phone:256-593-7063
Mailing Address - Fax:256-593-7445
Practice Address - Street 1:920 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:BOAZ
Practice Address - State:AL
Practice Address - Zip Code:35957-1732
Practice Address - Country:US
Practice Address - Phone:256-593-6092
Practice Address - Fax:256-593-7445
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-30
Last Update Date:2011-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL7525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist