Provider Demographics
NPI:1821199837
Name:ROSS, LATOYA (RPH)
Entity Type:Individual
Prefix:
First Name:LATOYA
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3798 FAIROAKS RD
Mailing Address - Street 2:
Mailing Address - City:SOUTH EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44121-1923
Mailing Address - Country:US
Mailing Address - Phone:216-445-2348
Mailing Address - Fax:
Practice Address - Street 1:2010 EAST 90TH STREET
Practice Address - Street 2:SUITE R16
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44106
Practice Address - Country:US
Practice Address - Phone:216-445-2348
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-1-24826183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist