Provider Demographics
NPI:1336738566
Name:GROSSE, KATE MARIE
Entity Type:Individual
Prefix:
First Name:KATE
Middle Name:MARIE
Last Name:GROSSE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12777 W IH 10
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78230-1014
Mailing Address - Country:US
Mailing Address - Phone:210-558-3027
Mailing Address - Fax:866-357-7376
Practice Address - Street 1:12777 W IH 10
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78230-1014
Practice Address - Country:US
Practice Address - Phone:210-558-3027
Practice Address - Fax:866-357-7376
Is Sole Proprietor?:No
Enumeration Date:2021-01-12
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX190388183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician