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General NPI Number Information
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NPI Number | 1831457183
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Entity Type | Organization
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Legal Business Name | PRN PHYSICIAN RECOMMENDED NUTRICEUTICALS, LLC
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Dates
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Enumeration Date | 04/24/2012
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Last Update Date | 04/24/2012
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Provider Practice Location Address
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Address Line | 502 W GERMANTOWN PIKE SUITE 610
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1309
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Country | US
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Telephone | 610-862-0182
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Fax | 610-862-0183
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Provider Business Mailing Address
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Address Line | 502 W GERMANTOWN PIKE SUITE 610
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City | PLYMOUTH MEETING
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State | PA
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Zip | 19462-1309
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Country | US
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Telephone | 610-862-0182
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Fax | 610-862-0183
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Authorized Official
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Title or Position | CHIEF MEDICAL OFFICER
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Name | DR. MICHAEL B GROSS
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Credential | M.D.
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Telephone | 610-862-0182
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332900000X
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Taxonomy Name | Non-Pharmacy Dispensing Site
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License Number |
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License Number State |
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