Provider Demographics
NPI:1568846327
Name:TELLINGHUISEN, ROSS (PHARMD)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:TELLINGHUISEN
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4409 E 26TH ST
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57103-4136
Mailing Address - Country:US
Mailing Address - Phone:605-367-2710
Mailing Address - Fax:605-367-2719
Practice Address - Street 1:4409 E 26TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57103-4136
Practice Address - Country:US
Practice Address - Phone:605-367-2710
Practice Address - Fax:605-367-2719
Is Sole Proprietor?:No
Enumeration Date:2015-07-11
Last Update Date:2015-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD6192183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist