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General NPI Number Information
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NPI Number | 1992867949
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Entity Type | Organization
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Legal Business Name | GROVE MEDICAL CENTER PHARMACY
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Dates
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Enumeration Date | 12/15/2006
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Last Update Date | 03/10/2020
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Provider Practice Location Address
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Address Line | 1143 S BUCKNER BLVD
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City | DALLAS
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State | TX
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Zip | 75217-4304
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Country | US
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Telephone | 214-391-2414
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Fax | 214-391-0832
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Provider Business Mailing Address
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Address Line | 1143 S BUCKNER BLVD
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City | DALLAS
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State | TX
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Zip | 75217-4304
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Country | US
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Telephone | 214-391-2414
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Fax | 214-391-0832
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Authorized Official
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Title or Position | PHARMACIST
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Name | JOHN DE LANGE
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Credential |
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Telephone | 214-391-2414
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | 13464
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License Number State | TX
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