Provider Demographics
NPI:1063586436
Name:LERCH, ROSS FREDERICK (RPH)
Entity type:Individual
Prefix:MR
First Name:ROSS
Middle Name:FREDERICK
Last Name:LERCH
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 1:3020 CAT TAIL LN
Mailing Address - Street 2:
Mailing Address - City:DEBARY
Mailing Address - State:FL
Mailing Address - Zip Code:32713-2775
Mailing Address - Country:US
Mailing Address - Phone:386-668-5268
Mailing Address - Fax:
Practice Address - Street 1:2880 HOWLAND BLVD
Practice Address - Street 2:
Practice Address - City:DELTONA
Practice Address - State:FL
Practice Address - Zip Code:32725-9619
Practice Address - Country:US
Practice Address - Phone:386-532-7178
Practice Address - Fax:386-532-7176
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS22676183500000X
OH03-3-16100183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist