Provider Demographics
NPI:1265741680
Name:FAIRCHILD, DAVID ROSS (PHARM D)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:ROSS
Last Name:FAIRCHILD
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10201 PARK ROWE AVE APT 3216
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70810-2299
Mailing Address - Country:US
Mailing Address - Phone:225-937-6024
Mailing Address - Fax:
Practice Address - Street 1:7411 FLORIDA BLVD
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70806-4639
Practice Address - Country:US
Practice Address - Phone:225-928-8982
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-10-04
Last Update Date:2022-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX49386183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist