1083737134 NPI number — DR. ROSS ALLEN EARDLEY PHARMD, BCPS

Table of content: DR. ROSS ALLEN EARDLEY PHARMD, BCPS (NPI 1083737134)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1083737134 NPI number — DR. ROSS ALLEN EARDLEY PHARMD, BCPS

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EARDLEY
Provider First Name:
ROSS
Provider Middle Name:
ALLEN
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARMD, BCPS
Provider Gender Code:
M

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1083737134
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/04/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1850 MORNING DEW DR SW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BYRON CENTER
Provider Business Mailing Address State Name:
MI
Provider Business Mailing Address Postal Code:
49315-8432
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
616-583-0607
Provider Business Mailing Address Fax Number:
616-252-6986

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5900 BYRON CENTER AVE SW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WYOMING
Provider Business Practice Location Address State Name:
MI
Provider Business Practice Location Address Postal Code:
49519-9606
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
616-252-7845
Provider Business Practice Location Address Fax Number:
616-252-6986
Provider Enumeration Date:
04/06/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1835P1200X , with the licence number:  5302032582 , registered in the state of MI ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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