Provider Demographics
NPI:1164709028
Name:GROTE, BENJAMIN RALPH (RPH)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:RALPH
Last Name:GROTE
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 1:502 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:NEBRASKA CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68410-2728
Mailing Address - Country:US
Mailing Address - Phone:402-873-1012
Mailing Address - Fax:402-873-1029
Practice Address - Street 1:502 S 11TH ST
Practice Address - Street 2:
Practice Address - City:NEBRASKA CITY
Practice Address - State:NE
Practice Address - Zip Code:68410-2728
Practice Address - Country:US
Practice Address - Phone:402-873-1012
Practice Address - Fax:402-893-1029
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-07
Last Update Date:2011-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE12056183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist