Provider Demographics
NPI:1730474610
Name:KURTZ, ROSS M (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROSS
Middle Name:M
Last Name:KURTZ
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 1:4020 MILAN RD
Mailing Address - Street 2:
Mailing Address - City:SANDUSKY
Mailing Address - State:OH
Mailing Address - Zip Code:44870-5892
Mailing Address - Country:US
Mailing Address - Phone:419-609-3341
Mailing Address - Fax:419-609-3351
Practice Address - Street 1:4020 MILAN RD
Practice Address - Street 2:
Practice Address - City:SANDUSKY
Practice Address - State:OH
Practice Address - Zip Code:44870-5892
Practice Address - Country:US
Practice Address - Phone:419-609-3341
Practice Address - Fax:419-609-3351
Is Sole Proprietor?:No
Enumeration Date:2011-06-18
Last Update Date:2011-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26020801A183500000X
OH03325512183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist