Provider Demographics
NPI:1588256945
Name:ROSS, TERESA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:TERESA
Middle Name:M
Last Name:ROSS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7473 SECOR RD STE C
Mailing Address - Street 2:
Mailing Address - City:LAMBERTVILLE
Mailing Address - State:MI
Mailing Address - Zip Code:48144-8686
Mailing Address - Country:US
Mailing Address - Phone:734-856-9123
Mailing Address - Fax:
Practice Address - Street 1:7473 SECOR RD STE C
Practice Address - Street 2:
Practice Address - City:LAMBERTVILLE
Practice Address - State:MI
Practice Address - Zip Code:48144-8686
Practice Address - Country:US
Practice Address - Phone:734-856-9123
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-02-08
Last Update Date:2021-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036165183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist