Organization
G AND J GROSS, INC.
Active
Other names
Mickey Fine Pharmacy
Organization subpart
No
Provider details
NPI number
Authorized official
JEFFREY GROSS (PRESIDENT)
(310) 271-6123
Entity
Organization
Contact information
Practice address
433 N ROXBURY DR, BEVERLY HILLS, CA 90210-5001
(310) 271-6123
(310) 273-5339
Mailing address
433 N ROXBURY DR, BEVERLY HILLS, CA 90210-5001
(310) 271-6123
(310) 273-5339
Taxonomy
Speciality
Code
Description
License number
State
163WD0400X
Diabetes Educator Registered Nurse
—
—
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
PHY51055
CA
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1083744916
—
CA
01
—
2136312
PK
—
Enumeration date
03/07/2007
Last updated
01/07/2019
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