Provider Demographics
NPI:1568503324
Name:GRUICH PHARMACY SHOPPE
Entity Type:Organization
Organization Name:GRUICH PHARMACY SHOPPE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:FRANK
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:GRUICH
Authorized Official - Suffix:JR
Authorized Official - Credentials:RPH
Authorized Official - Phone:228-435-4360
Mailing Address - Street 1:608 HOWARD AVE
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39530-4310
Mailing Address - Country:US
Mailing Address - Phone:228-435-4360
Mailing Address - Fax:
Practice Address - Street 1:608 HOWARD AVE
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39530-4310
Practice Address - Country:US
Practice Address - Phone:228-435-4360
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-12
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS0179301333600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy