Provider Demographics
NPI:1134253131
Name:ROSCELLI, DEBORAH L (PHARMD)
Entity type:Individual
Prefix:
First Name:DEBORAH
Middle Name:L
Last Name:ROSCELLI
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:DEBBIE
Other - Middle Name:
Other - Last Name:ROSCELLI
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PHARMD
Mailing Address - Street 1:4344 YACHT HARBOR DR
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:CA
Mailing Address - Zip Code:95204-1126
Mailing Address - Country:US
Mailing Address - Phone:209-942-4344
Mailing Address - Fax:
Practice Address - Street 1:4344 YACHT HARBOR DR
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:CA
Practice Address - Zip Code:95204-1126
Practice Address - Country:US
Practice Address - Phone:209-942-4344
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-03-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARPH 31884183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist