Healthcare Provider Details

I. General information

NPI: 1528045754
Provider Name (Legal Business Name): MRS. TAMMY S GROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 12/29/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3025 CARLISLE RD
DOVER PA
17315-4509
US

IV. Provider business mailing address

295 W CAMPING AREA RD
DOVER PA
17315-2154
US

V. Phone/Fax

Practice location:
  • Phone: 717-767-1482
  • Fax:
Mailing address:
  • Phone: 717-292-2764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP042379L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: