Provider Demographics
NPI:1104832385
Name:GRUBER, THOMAS BRUCE (RPH)
Entity Type:Individual
Prefix:MR
First Name:THOMAS
Middle Name:BRUCE
Last Name:GRUBER
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 272
Mailing Address - Street 2:
Mailing Address - City:DILLSBURG
Mailing Address - State:PA
Mailing Address - Zip Code:17019-1227
Mailing Address - Country:US
Mailing Address - Phone:717-432-5112
Mailing Address - Fax:717-432-0417
Practice Address - Street 1:18 SOUTH BALTIMORE ST
Practice Address - Street 2:
Practice Address - City:DILLSBURG
Practice Address - State:PA
Practice Address - Zip Code:17019-1227
Practice Address - Country:US
Practice Address - Phone:717-432-5112
Practice Address - Fax:717-432-0417
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP025369L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA3916674OtherNAPB
PA0635750001Medicare PIN