=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427706845
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN K ROSS
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/15/2022
-----------------------------------------------------
Last Update Date | 03/15/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 402 W WASHINGTON ST # MS 07W374
-----------------------------------------------------
City | INDIANAPOLIS
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46204-2243
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-232-4307
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5565 W WHITELAND RD
-----------------------------------------------------
City | BARGERSVILLE
-----------------------------------------------------
State | IN
-----------------------------------------------------
Zip | 46106-9082
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 317-441-1855
-----------------------------------------------------
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 | 26017696A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 28090521A
-----------------------------------------------------
License Number State | IN
-----------------------------------------------------