Healthcare Provider Details

I. General information

NPI: 1407939416
Provider Name (Legal Business Name): GROVE PHARMACY HOME INFUSION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/23/2006
Last Update Date: 08/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1522 E SUNSHINE ST
SPRINGFIELD MO
65804-1214
US

IV. Provider business mailing address

1522 E SUNSHINE ST
SPRINGFIELD MO
65804-1214
US

V. Phone/Fax

Practice location:
  • Phone: 417-881-2910
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code333600000X
TaxonomyPharmacy
License Number005915
License Number StateMO

VIII. Authorized Official

Name: GARY GROVE
Title or Position: PRES
Credential:
Phone: 417-881-2910