Provider Demographics
NPI:1801126040
Name:ROSS, DENNIS DARRELL (RPH)
Entity type:Individual
Prefix:MR
First Name:DENNIS
Middle Name:DARRELL
Last Name:ROSS
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1514 E FLORENCE BLVD
Mailing Address - Street 2:
Mailing Address - City:CASA GRANDE
Mailing Address - State:AZ
Mailing Address - Zip Code:85122-4741
Mailing Address - Country:US
Mailing Address - Phone:520-836-2787
Mailing Address - Fax:520-836-0372
Practice Address - Street 1:1514 E FLORENCE BLVD
Practice Address - Street 2:
Practice Address - City:CASA GRANDE
Practice Address - State:AZ
Practice Address - Zip Code:85122-4741
Practice Address - Country:US
Practice Address - Phone:520-836-2787
Practice Address - Fax:520-836-0372
Is Sole Proprietor?:No
Enumeration Date:2010-01-11
Last Update Date:2010-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS014627183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist