Provider Demographics
NPI:1619186483
Name:ROSS PARK PHARMACY INC
Entity Type:Organization
Organization Name:ROSS PARK PHARMACY INC
Other - Org Name:ROSS PARK PHARMACY WEST
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:GERALD
Authorized Official - Middle Name:WARREN
Authorized Official - Last Name:JOHN
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:740-264-8669
Mailing Address - Street 1:4100 JOHNSON RD
Mailing Address - Street 2:SUITE #105
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952-2300
Mailing Address - Country:US
Mailing Address - Phone:740-264-8222
Mailing Address - Fax:740-264-8233
Practice Address - Street 1:4100 JOHNSON RD
Practice Address - Street 2:SUITE #105
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952-2300
Practice Address - Country:US
Practice Address - Phone:740-264-8222
Practice Address - Fax:740-264-8233
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-21
Last Update Date:2008-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH02-17018003336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH02-1701800OtherTERM DIST DANGEROUS DRUGS