Provider Demographics
NPI:1174939565
Name:DR. ROSEANNE ABRAHAM, PHARMD
Entity type:Organization
Organization Name:DR. ROSEANNE ABRAHAM, PHARMD
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PHARMACIST
Authorized Official - Prefix:DR
Authorized Official - First Name:ROSEANNE
Authorized Official - Middle Name:S
Authorized Official - Last Name:ABRAHAM
Authorized Official - Suffix:
Authorized Official - Credentials:PHARMD
Authorized Official - Phone:617-947-9173
Mailing Address - Street 1:950 SOUTHERLY RD APT 381
Mailing Address - Street 2:
Mailing Address - City:TOWSON
Mailing Address - State:MD
Mailing Address - Zip Code:21204-2848
Mailing Address - Country:US
Mailing Address - Phone:617-947-9173
Mailing Address - Fax:
Practice Address - Street 1:9616 HARFORD RD
Practice Address - Street 2:
Practice Address - City:PARKVILLE
Practice Address - State:MD
Practice Address - Zip Code:21234-2104
Practice Address - Country:US
Practice Address - Phone:410-663-7957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-07
Last Update Date:2014-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD22461183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty