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General NPI Number Information
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NPI Number | 1558402073
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Entity Type | Individual
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Provider Name | ERIK RANDALL GROVE PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 02/08/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 835 W MAIN ST
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City | MADISON
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State | IN
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Zip | 47250-3131
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Country | US
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Telephone | 812-265-4621
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Fax | 812-273-6666
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Provider Business Mailing Address
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Address Line | 1802 SAINT ANDREWS CT
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City | LAGRANGE
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State | KY
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Zip | 40031-8942
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Country | US
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Telephone | 502-222-9678
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Fax | 812-273-6666
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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 | 12150
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26022241A
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License Number State | IN
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Taxonomy #3
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 51291460
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License Number State | IL
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