Provider Demographics
NPI:1942581814
Name:GROSCOST, BRENT DEVLIN (RPH)
Entity Type:Individual
Prefix:MR
First Name:BRENT
Middle Name:DEVLIN
Last Name:GROSCOST
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HUBBARD
Mailing Address - State:OH
Mailing Address - Zip Code:44425-2154
Mailing Address - Country:US
Mailing Address - Phone:330-534-4519
Mailing Address - Fax:330-534-4572
Practice Address - Street 1:15 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HUBBARD
Practice Address - State:OH
Practice Address - Zip Code:44425-2154
Practice Address - Country:US
Practice Address - Phone:330-534-4519
Practice Address - Fax:330-534-4572
Is Sole Proprietor?:No
Enumeration Date:2011-09-06
Last Update Date:2011-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03228445183500000X
PARP041926L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist