Provider Demographics
NPI:1376552232
Name:GROSS, MONTE JACK JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:MONTE
Middle Name:JACK
Last Name:GROSS
Suffix:JR
Gender:M
Credentials:RPH
Other - Prefix:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1212
Mailing Address - Street 2:225 EAST COLLEGE AVE.
Mailing Address - City:STANTON
Mailing Address - State:KY
Mailing Address - Zip Code:40380-1212
Mailing Address - Country:US
Mailing Address - Phone:606-663-2848
Mailing Address - Fax:606-663-0968
Practice Address - Street 1:163 EAST COLLEGE AVE
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:KY
Practice Address - Zip Code:40380-0037
Practice Address - Country:US
Practice Address - Phone:606-663-2848
Practice Address - Fax:606-663-0968
Is Sole Proprietor?:No
Enumeration Date:2006-08-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY7829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist