Provider Demographics
NPI:1447532502
Name:ROSS, NANCY JO (PHARMD, BCACP)
Entity type:Individual
Prefix:
First Name:NANCY
Middle Name:JO
Last Name:ROSS
Suffix:
Gender:F
Credentials:PHARMD, BCACP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:865 ORMEWOOD TER SE
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30316-2468
Mailing Address - Country:US
Mailing Address - Phone:770-331-1079
Mailing Address - Fax:
Practice Address - Street 1:340 BOULEVARD NE STE 143
Practice Address - Street 2:
Practice Address - City:ATLANTA
Practice Address - State:GA
Practice Address - Zip Code:30312-1278
Practice Address - Country:US
Practice Address - Phone:404-929-1013
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-09-14
Last Update Date:2013-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA021623183500000X
FLPS42131183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist