Provider Demographics
NPI:1740519610
Name:ROSS PARK PHARMACY INC
Entity type:Organization
Organization Name:ROSS PARK PHARMACY INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:STAFF ACCOUNTANT
Authorized Official - Prefix:
Authorized Official - First Name:CATHY
Authorized Official - Middle Name:L
Authorized Official - Last Name:CUCARESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:740-283-7841
Mailing Address - Street 1:4100 JOHNSON ROAD
Mailing Address - Street 2:SUITE 105
Mailing Address - City:STEUBENVILLE
Mailing Address - State:OH
Mailing Address - Zip Code:43952
Mailing Address - Country:US
Mailing Address - Phone:740-283-7841
Mailing Address - Fax:
Practice Address - Street 1:4100 JOHNSON ROAD
Practice Address - Street 2:SUITE 105
Practice Address - City:STEUBENVILLE
Practice Address - State:OH
Practice Address - Zip Code:43952
Practice Address - Country:US
Practice Address - Phone:740-283-7841
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2750483Medicaid