Provider Demographics
NPI:1427706845
Name:ROSS, JOHN K
Entity type:Individual
Prefix:
First Name:JOHN
Middle Name:K
Last Name:ROSS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5565 W WHITELAND RD
Mailing Address - Street 2:
Mailing Address - City:BARGERSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46106-9082
Mailing Address - Country:US
Mailing Address - Phone:317-441-1855
Mailing Address - Fax:
Practice Address - Street 1:402 W WASHINGTON ST # MS 07W374
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46204-2243
Practice Address - Country:US
Practice Address - Phone:317-232-4307
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26017696A183500000X
IN28090521A163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No163W00000XNursing Service ProvidersRegistered Nurse