Provider Demographics
NPI:1114212172
Name:ROSS, MARY BETH (RPH)
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:BETH
Last Name:ROSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:28539 MARLBORO AVE
Mailing Address - Street 2:
Mailing Address - City:EASTON
Mailing Address - State:MD
Mailing Address - Zip Code:21601-2752
Mailing Address - Country:US
Mailing Address - Phone:410-770-6181
Mailing Address - Fax:410-770-6190
Practice Address - Street 1:28539 MARLBORO AVE
Practice Address - Street 2:
Practice Address - City:EASTON
Practice Address - State:MD
Practice Address - Zip Code:21601-2752
Practice Address - Country:US
Practice Address - Phone:410-770-6181
Practice Address - Fax:410-770-6190
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD13774183500000X
WV3393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist