Provider Demographics
NPI:1922544956
Name:ROSS, DAVID JADIRI (PHARMD,)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:JADIRI
Last Name:ROSS
Suffix:
Gender:M
Credentials:PHARMD,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2509 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-1551
Mailing Address - Country:US
Mailing Address - Phone:254-939-0843
Mailing Address - Fax:254-933-3502
Practice Address - Street 1:2509 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-1551
Practice Address - Country:US
Practice Address - Phone:254-939-0843
Practice Address - Fax:254-933-3502
Is Sole Proprietor?:Yes
Enumeration Date:2017-01-14
Last Update Date:2017-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX55626183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist