Provider Demographics
NPI:1316618283
Name:RILLIAMS, ROSS (RPH)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:RILLIAMS
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 1:10816 N LAURENS SQ NE
Mailing Address - Street 2:
Mailing Address - City:BOLIVAR
Mailing Address - State:OH
Mailing Address - Zip Code:44612-8871
Mailing Address - Country:US
Mailing Address - Phone:330-447-3183
Mailing Address - Fax:
Practice Address - Street 1:11031 STATE ROUTE 212 NE
Practice Address - Street 2:
Practice Address - City:BOLIVAR
Practice Address - State:OH
Practice Address - Zip Code:44612-8744
Practice Address - Country:US
Practice Address - Phone:330-874-3723
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-21
Last Update Date:2021-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03116285183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist