Individual
THANE Z GROVER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
141 N. WASHINGTON ST., BROULIM'S PHARMACY, AFTON, WY 83110
(307) 885-5550
Mailing address
PO BOX 11, 883 STUMP CREEK RD, AUBURN, WY 83111-0011
(307) 413-1335
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
3605
WY
183500000X
Pharmacist
P6205
ID
183500000X
Pharmacist
RPH-0012033
OR
Other
Enumeration date
08/19/2008
Last updated
12/21/2012
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