Provider Demographics
NPI:1821389974
Name:JEROME, ROSS A JR (RPH)
Entity Type:Individual
Prefix:
First Name:ROSS
Middle Name:A
Last Name:JEROME
Suffix:JR
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 1:156 MAINE ST
Mailing Address - Street 2:RITE AID 4121
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011
Mailing Address - Country:US
Mailing Address - Phone:207-729-8100
Mailing Address - Fax:207-729-1355
Practice Address - Street 1:156 MAINE ST
Practice Address - Street 2:RITE AID 4121
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011
Practice Address - Country:US
Practice Address - Phone:207-729-8100
Practice Address - Fax:207-729-1355
Is Sole Proprietor?:No
Enumeration Date:2011-04-25
Last Update Date:2011-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR4275183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist