Provider Demographics
NPI:1407842107
Name:ROSS PARK PHARMACY INC
Entity Type:Organization
Organization Name:ROSS PARK PHARMACY INC
Other - Org Name:ROSS PARK PHARMACY
Other - Org Type:Other Name
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:
Authorized Official - Last Name:CONFORTI
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-283-7272
Mailing Address - Street 1:1 ROSS PARK BLVD
Mailing Address - Street 2:SUITE 100
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2671
Mailing Address - Country:US
Mailing Address - Phone:740-264-7740
Mailing Address - Fax:740-264-7636
Practice Address - Street 1:1 ROSS PARK BLVD
Practice Address - Street 2:SUITE 100
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2671
Practice Address - Country:US
Practice Address - Phone:740-264-7740
Practice Address - Fax:740-264-7636
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-09-27
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-17018003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0246871Medicaid
3655466OtherNABP NUMBER
OH010942550OtherOHIO TERM DISTRIBUTOR LIC
OH010942550OtherOHIO TERM DISTRIBUTOR LIC
1122040001Medicare ID - Type Unspecified