Provider Demographics
NPI:1164835641
Name:ROSS, MARK E (RPH)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:E
Last Name:ROSS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7700 N ALGER RD
Mailing Address - Street 2:
Mailing Address - City:ALMA
Mailing Address - State:MI
Mailing Address - Zip Code:48801-9320
Mailing Address - Country:US
Mailing Address - Phone:989-463-3220
Mailing Address - Fax:989-463-5686
Practice Address - Street 1:7700 N ALGER RD
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-9320
Practice Address - Country:US
Practice Address - Phone:989-463-3220
Practice Address - Fax:989-463-5686
Is Sole Proprietor?:No
Enumeration Date:2014-06-03
Last Update Date:2014-06-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024454183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist