Healthcare Provider Details

I. General information

NPI: 1215457817
Provider Name (Legal Business Name): JOHN W GROSS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/23/2017
Last Update Date: 06/25/2023
Certification Date: 06/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1048 N MCEWAN ST
CLARE MI
48617-1154
US

IV. Provider business mailing address

11271 HARRISON AVE
FARWELL MI
48622-9439
US

V. Phone/Fax

Practice location:
  • Phone: 989-386-2900
  • Fax: 989-386-3710
Mailing address:
  • Phone: 989-339-9008
  • Fax: 855-855-4919

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302027910
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: