Provider Demographics
NPI:1457785818
Name:ROSS, DENNISE (PHARMD, RPH)
Entity Type:Individual
Prefix:
First Name:DENNISE
Middle Name:
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHARMD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 N WESTERN AVE
Mailing Address - Street 2:
Mailing Address - City:WAUPACA
Mailing Address - State:WI
Mailing Address - Zip Code:54981-2201
Mailing Address - Country:US
Mailing Address - Phone:715-256-0400
Mailing Address - Fax:715-256-0402
Practice Address - Street 1:115 N WESTERN AVE
Practice Address - Street 2:
Practice Address - City:WAUPACA
Practice Address - State:WI
Practice Address - Zip Code:54981-2201
Practice Address - Country:US
Practice Address - Phone:715-256-0400
Practice Address - Fax:715-256-0402
Is Sole Proprietor?:No
Enumeration Date:2013-08-21
Last Update Date:2013-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14659-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist