=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124153077
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN D ROSS RPH
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/22/2007
-----------------------------------------------------
Last Update Date | 07/08/2007
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2640 NE 14TH ST
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34470-4802
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-622-6099
-----------------------------------------------------
Fax | 352-622-7120
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3440 SE 45TH ST
-----------------------------------------------------
City | OCALA
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 34480-9311
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 352-620-8485
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | PS0017688
-----------------------------------------------------
License Number State | FL
-----------------------------------------------------