Provider Demographics
NPI:1942555917
Name:GROLZ, BETTE ANN (RPH)
Entity Type:Individual
Prefix:MS
First Name:BETTE
Middle Name:ANN
Last Name:GROLZ
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:MRS
Other - First Name:BETTE
Other - Middle Name:ANN
Other - Last Name:RIBIS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:881 PUTNAM AVE
Mailing Address - Street 2:
Mailing Address - City:MERRICK
Mailing Address - State:NY
Mailing Address - Zip Code:11566-1213
Mailing Address - Country:US
Mailing Address - Phone:516-538-3099
Mailing Address - Fax:
Practice Address - Street 1:364 LONG BEACH RD
Practice Address - Street 2:
Practice Address - City:OCEANSIDE
Practice Address - State:NY
Practice Address - Zip Code:11572-2230
Practice Address - Country:US
Practice Address - Phone:516-766-2288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-17
Last Update Date:2012-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY030814-1183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist