Organization
GROVE PROFESSIONAL PHARMACY INC
Active
Other names
GROVE PHARMACY SOUTH
Organization subpart
No
Provider details
NPI number
Authorized official
GARY GROVE (PRES)
(417) 881-2910
Entity
Organization
Contact information
Practice address
1001 E PRIMROSE ST, SPRINGFIELD, MO 65807-5155
(417) 883-6800
(417) 883-3006
Mailing address
1522 E SUNSHINE ST, SPRINGFIELD, MO 65804-1214
(417) 881-2910
(417) 890-1579
Taxonomy
Speciality
Code
Description
License number
State
333600000X
Pharmacy
—
—
3336C0003X
Community/Retail Pharmacy
Primary
004562
MO
3336C0004X
Compounding Pharmacy
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
2623038
NCPDP PROVIDER IDENTIFICATION NUMBER
—
05
—
600309827
—
MO
Enumeration date
10/20/2006
Last updated
09/19/2012
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