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General NPI Number Information
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NPI Number | 1720263452
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Entity Type | Individual
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Provider Name | CHAD THOMAS ROSS RPH
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Gender | Male
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Dates
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Enumeration Date | 12/31/2007
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Last Update Date | 12/31/2007
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Provider Practice Location Address
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Address Line | 3761 MAIN ST SUITE 1
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City | WARRENSBURG
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State | NY
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Zip | 12885-1837
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Country | US
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Telephone | 518-623-2993
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Fax | 518-623-3169
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Provider Business Mailing Address
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Address Line | 3 SUGAR PINE RD
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City | QUEENSBURY
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State | NY
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Zip | 12804-1245
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Country | US
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Telephone |
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Fax |
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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 | 045727
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License Number State | NY
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