Provider Demographics
NPI:1740738087
Name:GROSSO, ALAN (RPH)
Entity Type:Individual
Prefix:MR
First Name:ALAN
Middle Name:
Last Name:GROSSO
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 1:14823 E BOBCAT PLZ
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN HILLS
Mailing Address - State:AZ
Mailing Address - Zip Code:85268-1219
Mailing Address - Country:US
Mailing Address - Phone:480-331-7433
Mailing Address - Fax:
Practice Address - Street 1:4505 E MCKELLIPS RD
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85215-2523
Practice Address - Country:US
Practice Address - Phone:480-641-6740
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-09-15
Last Update Date:2016-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZS018912183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist