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General NPI Number Information
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NPI Number | 1376552232
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Entity Type | Individual
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Provider Name | MONTE JACK GROSS JR. R.PH.
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Gender | Male
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Dates
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Enumeration Date | 08/07/2006
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 163 EAST COLLEGE AVE
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City | STANTON
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State | KY
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Zip | 40380-0037
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Country | US
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Telephone | 606-663-2848
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Fax | 606-663-0968
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Provider Business Mailing Address
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Address Line | PO BOX 1212 225 EAST COLLEGE AVE.
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City | STANTON
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State | KY
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Zip | 40380-1212
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Country | US
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Telephone | 606-663-2848
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Fax | 606-663-0968
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 7829
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License Number State | KY
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