Provider Demographics
NPI:1770188385
Name:GROVE, KACEY L
Entity Type:Individual
Prefix:
First Name:KACEY
Middle Name:L
Last Name:GROVE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1854 ASHCOMBE DR
Mailing Address - Street 2:
Mailing Address - City:DOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17315-3708
Mailing Address - Country:US
Mailing Address - Phone:171-796-8016
Mailing Address - Fax:
Practice Address - Street 1:1700 N GEORGE ST
Practice Address - Street 2:
Practice Address - City:YORK
Practice Address - State:PA
Practice Address - Zip Code:17404-1807
Practice Address - Country:US
Practice Address - Phone:717-848-6212
Practice Address - Fax:717-848-4610
Is Sole Proprietor?:No
Enumeration Date:2020-12-01
Last Update Date:2020-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP440077183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist