NPI Code Detail JSON Logo

1124275383 NPI number — THANE Z GROVER PHARM.D.

NPI Number: 1124275383
Health Care Provider/Practitioner: THANE Z GROVER PHARM.D.

Information about “1124275383” NPI (THANE Z GROVER PHARM.D.) exists in 1124275383 in HTML format HTML  |  1124275383 in plain Text format TXT  |  1124275383 in PDF (Portable Document Format) PDF  |  1124275383 in an XML format XML  formats.

NPI Number : 1124275383 – JSON Data Format

                
{
  "Npi": {
    "NPI": "1124275383",
    "EntityType": "Individual",
    "ReplacementNPI": null,
    "EIN": null,
    "IsSoleProprietor": "N",
    "IsOrgSubpart": null,
    "ParentOrgLBN": null,
    "ParentOrgTIN": null,
    "OrgName": null,
    "LastName": "GROVER",
    "FirstName": "THANE",
    "MiddleName": "Z",
    "NamePrefix": null,
    "NameSuffix": null,
    "Credential": "PHARM.D.",
    "OtherOrgName": null,
    "OtherOrgNameTypeCode": null,
    "OtherLastName": null,
    "OtherFirstName": null,
    "OtherMiddleName": null,
    "OtherNamePrefix": null,
    "OtherNameSuffix": null,
    "OtherCredential": null,
    "OtherLastNameTypeCode": null,
    "FirstLineMailingAddress": "PO BOX 11",
    "SecondLineMailingAddress": "883 STUMP CREEK RD",
    "MailingAddressCityName": "AUBURN",
    "MailingAddressStateName": "WY",
    "MailingAddressPostalCode": "83111-0011",
    "MailingAddressCountryCode": "US",
    "MailingAddressTelephoneNumber": "307-413-1335",
    "MailingAddressFaxNumber": null,
    "FirstLinePracticeLocationAddress": "141 N. WASHINGTON ST.",
    "SecondLinePracticeLocationAddress": "BROULIM'S PHARMACY",
    "PracticeLocationAddressCityName": "AFTON",
    "PracticeLocationAddressStateName": "WY",
    "PracticeLocationAddressPostalCode": "83110",
    "PracticeLocationAddressCountryCode": "US",
    "PracticeLocationAddressTelephoneNumber": "307-885-5550",
    "PracticeLocationAddressFaxNumber": null,
    "EnumerationDate": "08/19/2008",
    "LastUpdateDate": "12/21/2012",
    "NPIDeactivationReasonCode": null,
    "NPIDeactivationReason": null,
    "NPIDeactivationDate": null,
    "NPIReactivationDate": null,
    "GenderCode": "M",
    "Gender": "Male",
    "AuthorizedOfficialLastName": null,
    "AuthorizedOfficialFirstName": null,
    "AuthorizedOfficialMiddleName": null,
    "AuthorizedOfficialTitle": null,
    "AuthorizedOfficialNamePrefix": null,
    "AuthorizedOfficialNameSuffix": null,
    "AuthorizedOfficialCredential": null,
    "AuthorizedOfficialTelephoneNumber": null,
    "Taxonomies": {
      "Taxonomy": [
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "P6205",
          "LicenseNumberStateCode": "ID",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "RPH-0012033",
          "LicenseNumberStateCode": "OR",
          "PrimaryTaxonomySwitch": "N"
        },
        {
          "TaxonomyCode": "183500000X",
          "TaxonomyName": "Pharmacist",
          "LicenseNumber": "3605",
          "LicenseNumberStateCode": "WY",
          "PrimaryTaxonomySwitch": "Y"
        }
      ]
    },
    "HealthcareProviderTaxonomyGroups": null
  }
}
                
            

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