=====================================================
General NPI Number Information
=====================================================
NPI Number | 1366068710
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ROSS-SCOTT PHARMACY LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/22/2020
-----------------------------------------------------
Last Update Date | 11/28/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 802 TEXAS PKWY STE 2A
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-6400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-969-8695
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 802 TEXAS PKWY STE 2A
-----------------------------------------------------
City | STAFFORD
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 77477-6400
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 281-969-8695
-----------------------------------------------------
Fax | 832-539-1014
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | DELORES ROSS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 281-969-8695
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 3336L0003X
-----------------------------------------------------
Taxonomy Name | Long Term Care Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 3336C0003X
-----------------------------------------------------
Taxonomy Name | Community/Retail Pharmacy
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------