Provider Demographics
NPI:1467683441
Name:GROSSHEIM, RICHARD H (RPH)
Entity Type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:H
Last Name:GROSSHEIM
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 1:708 HWY 70 EAST-OTWAY
Mailing Address - Street 2:
Mailing Address - City:BEAUFORT
Mailing Address - State:NC
Mailing Address - Zip Code:28516
Mailing Address - Country:US
Mailing Address - Phone:252-838-1540
Mailing Address - Fax:252-838-1545
Practice Address - Street 1:1404 LIVE OAK ST.
Practice Address - Street 2:
Practice Address - City:BEAUFORT
Practice Address - State:NC
Practice Address - Zip Code:28516
Practice Address - Country:US
Practice Address - Phone:252-728-2006
Practice Address - Fax:252-728-4777
Is Sole Proprietor?:No
Enumeration Date:2009-08-07
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC12842183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC0165332Medicaid