Healthcare Provider Details

I. General information

NPI: 1730479858
Provider Name (Legal Business Name): THOMAS SCOTT ROSS R.PH,
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/11/2011
Last Update Date: 04/11/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2626 FORT CAMPBELL BLVD
HOPKINSVILLE KY
42240-4939
US

IV. Provider business mailing address

2626 FORT CAMPBELL BLVD
HOPKINSVILLE KY
42240-4939
US

V. Phone/Fax

Practice location:
  • Phone: 270-885-6025
  • Fax: 270-885-5065
Mailing address:
  • Phone: 270-885-6025
  • Fax: 270-885-5065

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number007400
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: