MEDICARE: DR. DALE ROBERT GROTHE PHARM.D., RP.H.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1835P1300X	Psychiatric Pharmacist	10441	MD

General Provider Information

NPI Number	:	1700883410
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. DALE ROBERT GROTHE PHARM.D., RP.H.

Provider Business Mailing Address
First Line	:	14 MARSHWOOD DR
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-3857
Country	:	US
Telephone Number	:	610-831-5432
Fax Number	:

Provider Business Practice Location Address
First Line	:	14 MARSHWOOD DR
Second Line	:
City	:	COLLEGEVILLE
State	:	PA
Zip	:	19426-3857
Country	:	US
Telephone Number	:	610-831-5432
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/07/2005
Last Update Date	:	07/08/2007

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