Healthcare Provider Details

I. General information

NPI: 1629119904
Provider Name (Legal Business Name): CHRISTINE LEA GROVES RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/09/2007
Last Update Date: 03/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1275 N HERMITAGE RD
HERMITAGE PA
16148-3110
US

IV. Provider business mailing address

4013 STATE ROUTE 18
WAMPUM PA
16157-2137
US

V. Phone/Fax

Practice location:
  • Phone: 724-346-5930
  • Fax:
Mailing address:
  • Phone: 724-535-4756
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP032542L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: