Provider Demographics
NPI:1942371059
Name:GROVE CITY PHARMACY, INC.
Entity Type:Organization
Organization Name:GROVE CITY PHARMACY, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JEFFREY
Authorized Official - Middle Name:P
Authorized Official - Last Name:MUSTOVIC
Authorized Official - Suffix:
Authorized Official - Credentials:RPH
Authorized Official - Phone:724-538-4240
Mailing Address - Street 1:220 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1224
Mailing Address - Country:US
Mailing Address - Phone:724-458-4155
Mailing Address - Fax:724-458-4995
Practice Address - Street 1:220 W MAIN ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1224
Practice Address - Country:US
Practice Address - Phone:724-458-4155
Practice Address - Fax:724-458-4995
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-11
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPP413483L3336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
PA0013007900001Medicaid
PA3965401OtherNCPDP #
PA3965401OtherNCPDP #
PA3965401OtherNCPDP #