Provider Demographics
NPI:1922195130
Name:GROVER PHARMACY INC.
Entity Type:Organization
Organization Name:GROVER PHARMACY INC.
Other - Org Name:GROVER PHARMACY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:WILLIAMS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:616-842-8152
Mailing Address - Street 1:10 S 3RD AVE
Mailing Address - Street 2:
Mailing Address - City:FRUITPORT
Mailing Address - State:MI
Mailing Address - Zip Code:49415-9699
Mailing Address - Country:US
Mailing Address - Phone:231-865-3345
Mailing Address - Fax:231-865-1255
Practice Address - Street 1:10 S 3RD AVE
Practice Address - Street 2:
Practice Address - City:FRUITPORT
Practice Address - State:MI
Practice Address - Zip Code:49415-9699
Practice Address - Country:US
Practice Address - Phone:231-865-3345
Practice Address - Fax:231-865-1255
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-07
Last Update Date:2016-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5587520001332B00000X, 3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI5587520001Medicare NSC