Provider Demographics
NPI:1114632270
Name:CROSS, JAMES DONALD
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:DONALD
Last Name:CROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:J
Other - Middle Name:DON
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH
Mailing Address - Street 1:10433 MONTICELLO FOREST CIR
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40299-4129
Mailing Address - Country:US
Mailing Address - Phone:502-645-2810
Mailing Address - Fax:
Practice Address - Street 1:10433 MONTICELLO FOREST CIR
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40299-4129
Practice Address - Country:US
Practice Address - Phone:502-645-2810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-01-23
Last Update Date:2023-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY010573183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes183500000XPharmacy Service ProvidersPharmacistGroup - Single Specialty