Provider Demographics
NPI:1407131303
Name:ROSS, RICHARD ALAN (RPH)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:ALAN
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 1:12098 LUSHER RD
Mailing Address - Street 2:WALGREEN'S #4824
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63138-1302
Mailing Address - Country:US
Mailing Address - Phone:314-355-0500
Mailing Address - Fax:314-355-9695
Practice Address - Street 1:12098 LUSHER RD
Practice Address - Street 2:WALGREEN'S #4824
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63138-1302
Practice Address - Country:US
Practice Address - Phone:314-355-0500
Practice Address - Fax:314-355-9695
Is Sole Proprietor?:Yes
Enumeration Date:2011-10-12
Last Update Date:2011-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO042176183500000X
IL051.034937183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist