Provider Demographics
NPI:1063852093
Name:ROSS, DANIEL DAVID (PHARMD)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:DAVID
Last Name:ROSS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4040 N ORACLE RD
Mailing Address - Street 2:
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85705-2720
Mailing Address - Country:US
Mailing Address - Phone:520-202-1502
Mailing Address - Fax:520-202-1512
Practice Address - Street 1:4040 N ORACLE RD
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85705-2720
Practice Address - Country:US
Practice Address - Phone:520-202-1502
Practice Address - Fax:520-202-1512
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-05
Last Update Date:2013-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS019842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist