MEDICARE: MR. JAMES A GROSS RPH

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	0202011535	VA

General Provider Information

NPI Number	:	1780712513
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. JAMES A GROSS RPH

Provider Business Mailing Address
First Line	:	3103 FLETCHER DR
Second Line	:
City	:	SAINT PAUL
State	:	VA
Zip	:	24283
Country	:	US
Telephone Number	:	276-762-7668
Fax Number	:

Provider Business Practice Location Address
First Line	:	3103 FLETCHER DR
Second Line	:
City	:	SAINT PAUL
State	:	VA
Zip	:	24283
Country	:	US
Telephone Number	:	276-762-7668
Fax Number	:

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

Provider Enumeration Date	:	03/01/2007
Last Update Date	:	07/08/2007

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