MEDICARE: MR. CARL W GROVE 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	PR3791	ME
2	183500000X	Pharmacist	18109	MA

General Provider Information

NPI Number	:	1982607164
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. CARL W GROVE RPH

Provider Business Mailing Address
First Line	:	PO BOX 896
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-0896
Country	:	US
Telephone Number	:	207-432-5111
Fax Number	:

Provider Business Practice Location Address
First Line	:	329 MAINE ST
Second Line	:
City	:	BRUNSWICK
State	:	ME
Zip	:	04011-3310
Country	:	US
Telephone Number	:	207-373-2235
Fax Number	:	207-373-2167

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

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	03/29/2008

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