Provider Demographics
NPI:1912216904
Name:GROSSMAN, NANCY RUTH (RPH)
Entity Type:Individual
Prefix:
First Name:NANCY
Middle Name:RUTH
Last Name:GROSSMAN
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:144 WHITE RD
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:NJ
Mailing Address - Zip Code:08527-5009
Mailing Address - Country:US
Mailing Address - Phone:732-547-1678
Mailing Address - Fax:
Practice Address - Street 1:144 WHITE RD
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:NJ
Practice Address - Zip Code:08527-5009
Practice Address - Country:US
Practice Address - Phone:732-547-1678
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-25
Last Update Date:2010-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJRI16924183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist