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General NPI Number Information
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NPI Number | 1568503324
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Entity Type | Organization
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Legal Business Name | GRUICH PHARMACY SHOPPE
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Dates
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Enumeration Date | 02/12/2007
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Last Update Date | 12/23/2008
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Provider Practice Location Address
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Address Line | 608 HOWARD AVE
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City | BILOXI
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State | MS
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Zip | 39530-4310
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Country | US
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Telephone | 228-435-4360
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Fax |
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Provider Business Mailing Address
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Address Line | 608 HOWARD AVE
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City | BILOXI
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State | MS
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Zip | 39530-4310
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Country | US
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Telephone | 228-435-4360
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. FRANK GEORGE GRUICH JR.
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Credential | RPH
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Telephone | 228-435-4360
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number | 0179301
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License Number State | MS
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