Provider Demographics
NPI:1619299401
Name:GROSS, DANA G (RPH)
Entity Type:Individual
Prefix:MR
First Name:DANA
Middle Name:G
Last Name:GROSS
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 1:5757 N STATE ROUTE 741
Mailing Address - Street 2:
Mailing Address - City:SPRINGBORO
Mailing Address - State:OH
Mailing Address - Zip Code:45066-7750
Mailing Address - Country:US
Mailing Address - Phone:937-748-9513
Mailing Address - Fax:
Practice Address - Street 1:625 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:SPRINGBORO
Practice Address - State:OH
Practice Address - Zip Code:45066-1111
Practice Address - Country:US
Practice Address - Phone:937-743-5696
Practice Address - Fax:937-743-5572
Is Sole Proprietor?:No
Enumeration Date:2010-02-19
Last Update Date:2010-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-16436183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist