MEDICARE: ELLI REYES-GROTE RPH

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	3524	RI

General Provider Information

NPI Number	:	1124018197
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELLI REYES-GROTE RPH

Provider Business Mailing Address
First Line	:	PO BOX 868
Second Line	:
City	:	MATAWAN
State	:	NJ
Zip	:	07747-0868
Country	:	US
Telephone Number	:	732-441-1006
Fax Number	:

Provider Business Practice Location Address
First Line	:	1075 STEPHENSON AVE
Second Line	:
City	:	FORT MONMOUTH
State	:	NJ
Zip	:	07703
Country	:	US
Telephone Number	:	732-532-2551
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/21/2005
Last Update Date	:	07/08/2007

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