Provider Demographics
NPI:1346636198
Name:ROSS, J. MICHAEL (RPH)
Entity Type:Individual
Prefix:MR
First Name:J. MICHAEL
Middle Name:
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 1:406 LINKS CROSSING DR
Mailing Address - Street 2:
Mailing Address - City:BLYTHEWOOD
Mailing Address - State:SC
Mailing Address - Zip Code:29016-7618
Mailing Address - Country:US
Mailing Address - Phone:803-606-9000
Mailing Address - Fax:803-786-8843
Practice Address - Street 1:406 LINKS CROSSING DR
Practice Address - Street 2:
Practice Address - City:BLYTHEWOOD
Practice Address - State:SC
Practice Address - Zip Code:29016-7618
Practice Address - Country:US
Practice Address - Phone:803-606-9000
Practice Address - Fax:803-786-8843
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-08
Last Update Date:2015-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC004792183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist