Provider Demographics
NPI:1366843765
Name:HOLTZHAUSEN, ROSANNA P (RPH)
Entity type:Individual
Prefix:
First Name:ROSANNA
Middle Name:P
Last Name:HOLTZHAUSEN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1430 BEAUMONT AVE
Mailing Address - Street 2:
Mailing Address - City:BEAUMONT
Mailing Address - State:CA
Mailing Address - Zip Code:92223-4704
Mailing Address - Country:US
Mailing Address - Phone:951-769-4095
Mailing Address - Fax:951-769-4096
Practice Address - Street 1:1430 BEAUMONT AVE
Practice Address - Street 2:
Practice Address - City:BEAUMONT
Practice Address - State:CA
Practice Address - Zip Code:92223-4704
Practice Address - Country:US
Practice Address - Phone:951-769-4095
Practice Address - Fax:951-769-4096
Is Sole Proprietor?:No
Enumeration Date:2014-09-04
Last Update Date:2014-09-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA55413183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA55413OtherBOARD OF PHARMACY