Provider Demographics
NPI:1982971040
Name:GROTE, ANDREW RYAN (RPH)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:RYAN
Last Name:GROTE
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 1:1628 KNOLL CREST DR
Mailing Address - Street 2:
Mailing Address - City:SHEBOYGAN
Mailing Address - State:WI
Mailing Address - Zip Code:53081-7546
Mailing Address - Country:US
Mailing Address - Phone:920-980-5199
Mailing Address - Fax:920-683-1216
Practice Address - Street 1:2702 CALUMET AVE
Practice Address - Street 2:
Practice Address - City:MANITOWOC
Practice Address - State:WI
Practice Address - Zip Code:54220-5547
Practice Address - Country:US
Practice Address - Phone:920-683-8887
Practice Address - Fax:920-683-1216
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-17
Last Update Date:2011-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI14013-40183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist