Healthcare Provider Details

I. General information

NPI: 1851398317
Provider Name (Legal Business Name): THOMAS T ROSS BS PHARMACY
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 06/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

620 N WILLOW ST
HARRISON AR
72601-2994
US

IV. Provider business mailing address

620 N WILLOW ST
HARRISON AR
72601-2994
US

V. Phone/Fax

Practice location:
  • Phone: 870-365-2018
  • Fax:
Mailing address:
  • Phone: 870-365-2018
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5925
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: