Provider Demographics
NPI:1326082082
Name:GROSSMAN, ALBERT AVINOAM (RPH MS)
Entity Type:Individual
Prefix:MR
First Name:ALBERT
Middle Name:AVINOAM
Last Name:GROSSMAN
Suffix:
Gender:M
Credentials:RPH MS
Other - Prefix:MR
Other - First Name:ALBERT
Other - Middle Name:AVINOAM
Other - Last Name:GROSSMAN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RPH MS
Mailing Address - Street 1:1404 COMMERCE DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75093-2638
Mailing Address - Country:US
Mailing Address - Phone:972-964-9804
Mailing Address - Fax:972-964-9804
Practice Address - Street 1:2310 LBJ FREEWAY
Practice Address - Street 2:SUITE 100
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7335
Practice Address - Country:US
Practice Address - Phone:972-929-7105
Practice Address - Fax:800-965-7105
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-06-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX33666183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist