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General NPI Number Information
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NPI Number | 1083737134
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Entity Type | Individual
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Provider Name | ROSS ALLEN EARDLEY PHARMD, BCPS
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Gender | Male
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Dates
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Enumeration Date | 04/06/2007
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Last Update Date | 05/04/2015
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Provider Practice Location Address
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Address Line | 5900 BYRON CENTER AVE SW
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City | WYOMING
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State | MI
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Zip | 49519-9606
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Country | US
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Telephone | 616-252-7845
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Fax | 616-252-6986
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Provider Business Mailing Address
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Address Line | 1850 MORNING DEW DR SW
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City | BYRON CENTER
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State | MI
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Zip | 49315-8432
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Country | US
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Telephone | 616-583-0607
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Fax | 616-252-6986
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1835P1200X
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Taxonomy Name | Pharmacotherapy Pharmacist
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License Number | 5302032582
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License Number State | MI
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