Provider Demographics
NPI:1902042203
Name:GRUSZYNSKI, ROBERT JAMES (RPH)
Entity Type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JAMES
Last Name:GRUSZYNSKI
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:PO BOX 1097
Mailing Address - Street 2:101 PINE AVE.
Mailing Address - City:HILL CITY
Mailing Address - State:SD
Mailing Address - Zip Code:57745-1097
Mailing Address - Country:US
Mailing Address - Phone:605-574-9024
Mailing Address - Fax:
Practice Address - Street 1:101 PINE AVE
Practice Address - Street 2:
Practice Address - City:HILL CITY
Practice Address - State:SD
Practice Address - Zip Code:57745-1097
Practice Address - Country:US
Practice Address - Phone:605-574-9024
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-17
Last Update Date:2011-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK1359183500000X
SDR4750183500000X
TX29191183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist