Healthcare Provider Details

I. General information

NPI: 1679046775
Provider Name (Legal Business Name): GROVE RX INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2019
Last Update Date: 08/08/2024
Certification Date: 08/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

655 N FAIR OAKS AVE
PASADENA CA
91103-3383
US

IV. Provider business mailing address

655 N FAIR OAKS AVE
PASADENA CA
91103-3383
US

V. Phone/Fax

Practice location:
  • Phone: 626-390-4011
  • Fax: 626-640-3072
Mailing address:
  • Phone: 626-390-4011
  • Fax: 626-640-3072

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: ARMAN POGOSSIAN
Title or Position: PRESIDENT/CEO
Credential:
Phone: 626-390-4011