Provider Demographics
NPI:1801201058
Name:MERIDETH, ROSS (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:ROSS
Middle Name:
Last Name:MERIDETH
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:808 HUNTER AVE
Mailing Address - Street 2:STE. 1A
Mailing Address - City:SIKESTON
Mailing Address - State:MO
Mailing Address - Zip Code:63801-2248
Mailing Address - Country:US
Mailing Address - Phone:573-475-1900
Mailing Address - Fax:573-472-1814
Practice Address - Street 1:808 HUNTER AVE
Practice Address - Street 2:STE. 1A
Practice Address - City:SIKESTON
Practice Address - State:MO
Practice Address - Zip Code:63801-2248
Practice Address - Country:US
Practice Address - Phone:573-475-1900
Practice Address - Fax:573-472-1814
Is Sole Proprietor?:No
Enumeration Date:2014-06-26
Last Update Date:2014-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011026601183500000X, 1835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy