Provider Demographics
NPI:1518359546
Name:CENTANNI, ROSS (RPH)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:CENTANNI
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 1:5440 HIGHWAY 90 W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36619-4227
Mailing Address - Country:US
Mailing Address - Phone:251-602-1811
Mailing Address - Fax:
Practice Address - Street 1:5440 HIGHWAY 90 W
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36619-4227
Practice Address - Country:US
Practice Address - Phone:251-602-1811
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-27
Last Update Date:2015-02-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL11789183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL11489OtherALABAMA LIC#