Provider Demographics
NPI:1851398317
Name:ROSS, THOMAS T (BS PHARMACY)
Entity Type:Individual
Prefix:
First Name:THOMAS
Middle Name:T
Last Name:ROSS
Suffix:
Gender:M
Credentials:BS PHARMACY
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:620 N WILLOW ST
Mailing Address - Street 2:
Mailing Address - City:HARRISON
Mailing Address - State:AR
Mailing Address - Zip Code:72601-2994
Mailing Address - Country:US
Mailing Address - Phone:870-365-2018
Mailing Address - Fax:
Practice Address - Street 1:620 N WILLOW ST
Practice Address - Street 2:
Practice Address - City:HARRISON
Practice Address - State:AR
Practice Address - Zip Code:72601-2994
Practice Address - Country:US
Practice Address - Phone:870-365-2018
Practice Address - Fax:
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-06-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR5925183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist