Provider Demographics
NPI:1275630220
Name:CROSS, DAVID ROY (RPH)
Entity Type:Individual
Prefix:MR
First Name:DAVID
Middle Name:ROY
Last Name:CROSS
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 1:103 W 9TH AVE
Mailing Address - Street 2:
Mailing Address - City:ELLENSBURG
Mailing Address - State:WA
Mailing Address - Zip Code:98926-2907
Mailing Address - Country:US
Mailing Address - Phone:509-925-5104
Mailing Address - Fax:509-925-1545
Practice Address - Street 1:414 N PEARL ST
Practice Address - Street 2:
Practice Address - City:ELLENSBURG
Practice Address - State:WA
Practice Address - Zip Code:98926-3112
Practice Address - Country:US
Practice Address - Phone:509-925-1514
Practice Address - Fax:509-925-1545
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAPH00009284183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist