Healthcare Provider Details

I. General information

NPI: 1063496370
Provider Name (Legal Business Name): JOHN DANIEL GROSS RPH
Entity Type: Individual
Gender: Male
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 11/30/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

247 EXPRESSWAY CT
VIRGINIA BEACH VA
23462-6526
US

IV. Provider business mailing address

6133 ROLFE AVE
NORFOLK VA
23508-1025
US

V. Phone/Fax

Practice location:
  • Phone: 757-499-9637
  • Fax: 757-473-9227
Mailing address:
  • Phone: 757-451-8052
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202005695
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: