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General NPI Number Information
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NPI Number | 1134266752
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Entity Type | Individual
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Provider Name | MARK ANTHONY ROSS I PHARM.D
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Gender | Male
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Dates
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Enumeration Date | 01/31/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 5170 ROUTE 60 EAST AUITE 2800
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City | HUNTINGTON
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State | WV
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Zip | 25705
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Country | US
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Telephone | 304-634-1247
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Fax | 304-399-3785
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Provider Business Mailing Address
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Address Line | 315 ROYAL BIRKDALE DR
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City | LAVALETTE
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State | WV
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Zip | 25535-9617
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Country | US
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Telephone | 304-634-1247
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Fax | 304-399-3785
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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 | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 5849
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License Number State | WV
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