MEDICARE: MR. PHILLIP EUGENE GRUBER R.PH.

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	183500000X	Pharmacist	0202005243	VA

General Provider Information

NPI Number	:	1770591281
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PHILLIP EUGENE GRUBER R.PH.

Provider Business Mailing Address
First Line	:	1046 INDIAN SPRINGS LN
Second Line	:
City	:	MONETA
State	:	VA
Zip	:	24121-4828
Country	:	US
Telephone Number	:	540-297-7010
Fax Number	:

Provider Business Practice Location Address
First Line	:	1046 INDIAN SPRINGS LN
Second Line	:
City	:	MONETA
State	:	VA
Zip	:	24121-4828
Country	:	US
Telephone Number	:	540-297-7010
Fax Number	:

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

Provider Enumeration Date	:	08/03/2006
Last Update Date	:	07/08/2007

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