Provider Demographics
NPI:1457625873
Name:ROSS, MEREDITH D (PHARMD)
Entity Type:Individual
Prefix:
First Name:MEREDITH
Middle Name:D
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2204 E MAIN ST
Mailing Address - Street 2:
Mailing Address - City:STIGLER
Mailing Address - State:OK
Mailing Address - Zip Code:74462-2822
Mailing Address - Country:US
Mailing Address - Phone:918-967-9200
Mailing Address - Fax:918-967-9220
Practice Address - Street 1:2204 E MAIN ST
Practice Address - Street 2:
Practice Address - City:STIGLER
Practice Address - State:OK
Practice Address - Zip Code:74462-2822
Practice Address - Country:US
Practice Address - Phone:918-967-9200
Practice Address - Fax:918-967-9220
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK14051183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist