Provider Demographics
NPI:1265609044
Name:GROSSI, PERRY
Entity type:Individual
Prefix:MR
First Name:PERRY
Middle Name:
Last Name:GROSSI
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MILLSTONE RD
Mailing Address - Street 2:
Mailing Address - City:CLARKSBURG
Mailing Address - State:NJ
Mailing Address - Zip Code:08510-1521
Mailing Address - Country:US
Mailing Address - Phone:732-935-0844
Mailing Address - Fax:
Practice Address - Street 1:411 MILLSTONE RD
Practice Address - Street 2:
Practice Address - City:CLARKSBURG
Practice Address - State:NJ
Practice Address - Zip Code:08510-1521
Practice Address - Country:US
Practice Address - Phone:732-935-0844
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-12
Last Update Date:2008-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ17403183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist