Provider Demographics
NPI:1356857296
Name:ROSS, ROBERT P (PHARMACIST)
Entity Type:Individual
Prefix:
First Name:ROBERT
Middle Name:P
Last Name:ROSS
Suffix:
Gender:M
Credentials:PHARMACIST
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1845 WEDGEFIELD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MI
Mailing Address - Zip Code:49201-8346
Mailing Address - Country:US
Mailing Address - Phone:517-262-0124
Mailing Address - Fax:
Practice Address - Street 1:1601 E MICHIGAN AVE STE 2
Practice Address - Street 2:
Practice Address - City:LANSING
Practice Address - State:MI
Practice Address - Zip Code:48912-2894
Practice Address - Country:US
Practice Address - Phone:888-578-3044
Practice Address - Fax:517-485-4789
Is Sole Proprietor?:No
Enumeration Date:2017-12-14
Last Update Date:2017-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302019372183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist