Provider Demographics
NPI:1598054843
Name:PELTON, MONTROSS PATTERSON (R PH)
Entity Type:Individual
Prefix:
First Name:MONTROSS
Middle Name:PATTERSON
Last Name:PELTON
Suffix:
Gender:M
Credentials:R PH
Other - Prefix:
Other - First Name:ROSS
Other - Middle Name:
Other - Last Name:PELTON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:R PH
Mailing Address - Street 1:994 MORTON ST
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97520
Mailing Address - Country:US
Mailing Address - Phone:541-552-9499
Mailing Address - Fax:
Practice Address - Street 1:2341 ASHLAND ST
Practice Address - Street 2:
Practice Address - City:ASHLAND
Practice Address - State:OR
Practice Address - Zip Code:97520-1407
Practice Address - Country:US
Practice Address - Phone:541-482-7409
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-04-06
Last Update Date:2011-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORRPH 10267183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist