Provider Demographics
NPI:1699132779
Name:PLUMB, GARY ROSS
Entity type:Individual
Prefix:MR
First Name:GARY
Middle Name:ROSS
Last Name:PLUMB
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 1:1069 WOODVIEW DR
Mailing Address - Street 2:
Mailing Address - City:FLINT
Mailing Address - State:MI
Mailing Address - Zip Code:48507-4719
Mailing Address - Country:US
Mailing Address - Phone:702-372-0687
Mailing Address - Fax:
Practice Address - Street 1:1621 E M 21
Practice Address - Street 2:
Practice Address - City:OWOSSO
Practice Address - State:MI
Practice Address - Zip Code:48867-9053
Practice Address - Country:US
Practice Address - Phone:989-723-2656
Practice Address - Fax:989-725-6254
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-21
Last Update Date:2016-01-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410773183500000X
NV14393183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist