Provider Demographics
NPI:1780415786
Name:GROSE, MICHELLE KAY (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MICHELLE
Middle Name:KAY
Last Name:GROSE
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:MICHELLE
Other - Middle Name:KAY
Other - Last Name:NOVOBILSKY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:115 VICTORIA FALLS DR
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-1106
Mailing Address - Country:US
Mailing Address - Phone:304-692-9960
Mailing Address - Fax:
Practice Address - Street 1:500 SUNCREST TOWN CENTRE DR
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26505-1820
Practice Address - Country:US
Practice Address - Phone:304-285-6781
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-08-12
Last Update Date:2024-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0014236183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist