Healthcare Provider Details

I. General information

NPI: 1750692901
Provider Name (Legal Business Name): PETER ALEXANDER GRUJICH RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/22/2010
Last Update Date: 06/22/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4770 MCKNIGHT RD
PITTSBURGH PA
15237-3416
US

IV. Provider business mailing address

4770 MCKNIGHT RD
PITTSBURGH PA
15237-3416
US

V. Phone/Fax

Practice location:
  • Phone: 412-364-8100
  • Fax: 412-364-8610
Mailing address:
  • Phone: 412-364-8100
  • Fax: 412-364-8610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP-032717L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: