Provider Demographics
NPI:1326672601
Name:ROSS, DAVID LLOYD (PHARMD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:LLOYD
Last Name:ROSS
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1305
Mailing Address - Street 2:
Mailing Address - City:FORT DEFIANCE
Mailing Address - State:AZ
Mailing Address - Zip Code:86504-1305
Mailing Address - Country:US
Mailing Address - Phone:303-929-0522
Mailing Address - Fax:
Practice Address - Street 1:2102 CEDAR CIRCLE
Practice Address - Street 2:
Practice Address - City:FT DEFIANCE
Practice Address - State:AZ
Practice Address - Zip Code:86504-1305
Practice Address - Country:US
Practice Address - Phone:928-729-8324
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPHA.0022919208U00000X, 1835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208U00000XAllopathic & Osteopathic PhysiciansClinical Pharmacology
No1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist