Provider Demographics
NPI:1750681789
Name:EKLUND, ROSS
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:EKLUND
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20205 N 67TH AVE
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85308-6659
Mailing Address - Country:US
Mailing Address - Phone:623-572-8844
Mailing Address - Fax:623-572-8837
Practice Address - Street 1:20205 N 67TH AVE
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85308-6659
Practice Address - Country:US
Practice Address - Phone:623-572-8844
Practice Address - Fax:623-572-8837
Is Sole Proprietor?:No
Enumeration Date:2010-10-25
Last Update Date:2010-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS017248183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist