Provider Demographics
NPI:1902186513
Name:GROSS, CHERYL A (RPH AND PHARM D)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:A
Last Name:GROSS
Suffix:
Gender:F
Credentials:RPH AND PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:295 US HIGHWAY 45
Mailing Address - Street 2:
Mailing Address - City:GRAYSLAKE
Mailing Address - State:IL
Mailing Address - Zip Code:60030-2205
Mailing Address - Country:US
Mailing Address - Phone:847-223-9261
Mailing Address - Fax:847-223-5532
Practice Address - Street 1:295 US HIGHWAY 45
Practice Address - Street 2:
Practice Address - City:GRAYSLAKE
Practice Address - State:IL
Practice Address - Zip Code:60030-2205
Practice Address - Country:US
Practice Address - Phone:847-223-9261
Practice Address - Fax:847-223-5532
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-26
Last Update Date:2011-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051035297183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist