MEDICARE: MR. NICHOLAS R. GROSS

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	4431	SC

General Provider Information

NPI Number	:	1881752574
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. NICHOLAS R. GROSS

Provider Business Mailing Address
First Line	:	504 WOTAN RD
Second Line	:
City	:	COLUMBIA
State	:	SC
Zip	:	29229-3348
Country	:	US
Telephone Number	:	803-424-0024
Fax Number	:	803-424-0065

Provider Business Practice Location Address
First Line	:	1023A W DEKALB ST
Second Line	:
City	:	CAMDEN
State	:	SC
Zip	:	29020-4162
Country	:	US
Telephone Number	:	803-424-0064
Fax Number	:	803-424-0065

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

Provider Enumeration Date	:	12/05/2006
Last Update Date	:	05/31/2026

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