Provider Demographics
NPI:1730796285
Name:ROSALES, JOSEPH MARQUEZ (PH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:MARQUEZ
Last Name:ROSALES
Suffix:
Gender:M
Credentials:PH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 SAINT JAMES CT
Mailing Address - Street 2:
Mailing Address - City:GALT
Mailing Address - State:CA
Mailing Address - Zip Code:95632-8154
Mailing Address - Country:US
Mailing Address - Phone:916-236-7645
Mailing Address - Fax:
Practice Address - Street 1:5880 STOCKTON BLVD STE C
Practice Address - Street 2:
Practice Address - City:SACRAMENTO
Practice Address - State:CA
Practice Address - Zip Code:95824-3055
Practice Address - Country:US
Practice Address - Phone:916-706-0278
Practice Address - Fax:916-538-6965
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-29
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA82513183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist