Provider Demographics
NPI:1932633567
Name:BEVEVINO, ROSS (RPH)
Entity type:Individual
Prefix:
First Name:ROSS
Middle Name:
Last Name:BEVEVINO
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 1:1100 W CHESTNUT ST
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:15301-4631
Mailing Address - Country:US
Mailing Address - Phone:724-223-7710
Mailing Address - Fax:724-223-7712
Practice Address - Street 1:1100 W CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:PA
Practice Address - Zip Code:15301-4631
Practice Address - Country:US
Practice Address - Phone:724-223-7710
Practice Address - Fax:724-223-7712
Is Sole Proprietor?:Yes
Enumeration Date:2017-04-20
Last Update Date:2017-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP025774L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist