Provider Demographics
NPI:1356065353
Name:ROSS, LONNIE J (RPH)
Entity type:Individual
Prefix:
First Name:LONNIE
Middle Name:J
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 1:4269 QUAKER VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:ALUM BANK
Mailing Address - State:PA
Mailing Address - Zip Code:15521-8108
Mailing Address - Country:US
Mailing Address - Phone:814-285-2186
Mailing Address - Fax:
Practice Address - Street 1:4269 QUAKER VALLEY RD
Practice Address - Street 2:
Practice Address - City:ALUM BANK
Practice Address - State:PA
Practice Address - Zip Code:15521-8108
Practice Address - Country:US
Practice Address - Phone:814-285-2186
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-10-03
Last Update Date:2022-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP4424811835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist