Provider Demographics
NPI:1487976312
Name:ROSEN, CARYN (RPH)
Entity type:Individual
Prefix:
First Name:CARYN
Middle Name:
Last Name:ROSEN
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 1:296 RT 59
Mailing Address - Street 2:
Mailing Address - City:TALLMAN
Mailing Address - State:NY
Mailing Address - Zip Code:10982
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:296 RT 59
Practice Address - Street 2:
Practice Address - City:TALLMAN
Practice Address - State:NY
Practice Address - Zip Code:10982
Practice Address - Country:US
Practice Address - Phone:845-368-9700
Practice Address - Fax:845-368-4056
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY048969-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist