Provider Demographics
NPI:1083737134
Name:EARDLEY, ROSS ALLEN (PHARMD, BCPS)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:ALLEN
Last Name:EARDLEY
Suffix:
Gender:M
Credentials:PHARMD, BCPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1850 MORNING DEW DR SW
Mailing Address - Street 2:
Mailing Address - City:BYRON CENTER
Mailing Address - State:MI
Mailing Address - Zip Code:49315-8432
Mailing Address - Country:US
Mailing Address - Phone:616-583-0607
Mailing Address - Fax:616-252-6986
Practice Address - Street 1:5900 BYRON CENTER AVE SW
Practice Address - Street 2:
Practice Address - City:WYOMING
Practice Address - State:MI
Practice Address - Zip Code:49519-9606
Practice Address - Country:US
Practice Address - Phone:616-252-7845
Practice Address - Fax:616-252-6986
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-06
Last Update Date:2015-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI53020325821835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy