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NPI Code Detail

MEDICARE: DR. CAMILLE ROSE ROSS

MEDICARE: DR. CAMILLE ROSE ROSS
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist5302415622MI

General Provider Information

NPI Number : 1457131005
Entity Type Code : Individual
Provider Name (Legal Business Name) : DR. CAMILLE ROSE ROSS
Provider Business Mailing Address
First Line : 8765 FLAT CREEK DR UNIT N
Second Line :
City : ROCKFORD
State : MI
Zip : 49341-8946
Country : US
Telephone Number : 708-446-5169
Fax Number :
Provider Business Practice Location Address
First Line : 800 LEONARD ST NW
Second Line :
City : GRAND RAPIDS
State : MI
Zip : 49504-4148
Country : US
Telephone Number : 616-458-8300
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/02/2023
Last Update Date : 10/02/2023

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Directions to “ DR. CAMILLE ROSE ROSS ” Practice Location

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