Healthcare Provider Details

I. General information

NPI: 1710233812
Provider Name (Legal Business Name): KRISTINA BETH GROVE PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/26/2012
Last Update Date: 07/26/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 UNION RD
ORCHARD PARK NY
14127-1215
US

IV. Provider business mailing address

4028 WILLOWDALE AVE
BLASDELL NY
14219-2722
US

V. Phone/Fax

Practice location:
  • Phone: 716-677-4360
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number056968
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: