Provider Demographics
NPI:1982607164
Name:GROVE, CARL W (RPH)
Entity Type:Individual
Prefix:MR
First Name:CARL
Middle Name:W
Last Name:GROVE
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:PO BOX 896
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:ME
Mailing Address - Zip Code:04011-0896
Mailing Address - Country:US
Mailing Address - Phone:207-432-5111
Mailing Address - Fax:
Practice Address - Street 1:329 MAINE ST
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:ME
Practice Address - Zip Code:04011-3310
Practice Address - Country:US
Practice Address - Phone:207-373-2235
Practice Address - Fax:207-373-2167
Is Sole Proprietor?:No
Enumeration Date:2005-05-23
Last Update Date:2008-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MEPR3791183500000X
MA18109183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist