Provider Demographics
NPI:1831457183
Name:PRN PHYSICIAN RECOMMENDED NUTRICEUTICALS, LLC
Entity Type:Organization
Organization Name:PRN PHYSICIAN RECOMMENDED NUTRICEUTICALS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF MEDICAL OFFICER
Authorized Official - Prefix:DR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:B
Authorized Official - Last Name:GROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:610-862-0182
Mailing Address - Street 1:502 W GERMANTOWN PIKE
Mailing Address - Street 2:SUITE 610
Mailing Address - City:PLYMOUTH MEETING
Mailing Address - State:PA
Mailing Address - Zip Code:19462-1309
Mailing Address - Country:US
Mailing Address - Phone:610-862-0182
Mailing Address - Fax:610-862-0183
Practice Address - Street 1:502 W GERMANTOWN PIKE
Practice Address - Street 2:SUITE 610
Practice Address - City:PLYMOUTH MEETING
Practice Address - State:PA
Practice Address - Zip Code:19462-1309
Practice Address - Country:US
Practice Address - Phone:610-862-0182
Practice Address - Fax:610-862-0183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-04-24
Last Update Date:2012-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site