Provider Demographics
NPI:1124153077
Name:ROSS, JOHN D (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:D
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 1:3440 SE 45TH ST
Mailing Address - Street 2:
Mailing Address - City:OCALA
Mailing Address - State:FL
Mailing Address - Zip Code:34480-9311
Mailing Address - Country:US
Mailing Address - Phone:352-620-8485
Mailing Address - Fax:
Practice Address - Street 1:2640 NE 14TH ST
Practice Address - Street 2:
Practice Address - City:OCALA
Practice Address - State:FL
Practice Address - Zip Code:34470-4802
Practice Address - Country:US
Practice Address - Phone:352-622-6099
Practice Address - Fax:352-622-7120
Is Sole Proprietor?:No
Enumeration Date:2007-02-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS0017688183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL0556050211Medicare ID - Type Unspecified