Provider Demographics
NPI:1659972107
Name:GRUENKE, JANE (RPH)
Entity Type:Individual
Prefix:
First Name:JANE
Middle Name:
Last Name:GRUENKE
Suffix:
Gender:F
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:E7220 PARKER LN
Mailing Address - Street 2:
Mailing Address - City:BESSEMER
Mailing Address - State:MI
Mailing Address - Zip Code:49911-9719
Mailing Address - Country:US
Mailing Address - Phone:906-364-3080
Mailing Address - Fax:
Practice Address - Street 1:N10305 COUNTRY CLUB RD
Practice Address - Street 2:
Practice Address - City:IRONWOOD
Practice Address - State:MI
Practice Address - Zip Code:49938-9627
Practice Address - Country:US
Practice Address - Phone:906-932-4191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302024263183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist