Provider Demographics
NPI:1033553169
Name:ROSS, KATIE MARIE (PHARM D)
Entity Type:Individual
Prefix:
First Name:KATIE
Middle Name:MARIE
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5260 128TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:SPICER
Mailing Address - State:MN
Mailing Address - Zip Code:56288-8419
Mailing Address - Country:US
Mailing Address - Phone:320-444-2989
Mailing Address - Fax:
Practice Address - Street 1:5260 128TH AVE NE
Practice Address - Street 2:
Practice Address - City:SPICER
Practice Address - State:MN
Practice Address - Zip Code:56288-8419
Practice Address - Country:US
Practice Address - Phone:320-444-2989
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-04-19
Last Update Date:2013-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN120399183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist