Healthcare Provider Details

I. General information

NPI: 1023513876
Provider Name (Legal Business Name): ROSS BROTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/26/2018
Last Update Date: 03/26/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

26191 JOHN J WILLIAMS HWY
MILLSBORO DE
19966-4950
US

IV. Provider business mailing address

30396 ANDERSON DR UNIT 208
OCEAN VIEW DE
19970-3857
US

V. Phone/Fax

Practice location:
  • Phone: 302-945-6060
  • Fax:
Mailing address:
  • Phone: 717-683-5950
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0005083
License Number StateDE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: