Individual
DR. JACK B GROSS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARMD
Contact information
Practice address
106 CHERRY DR, HARRODSBURG, KY 40330
(859) 324-5543
Mailing address
106 CHERRY DR, HARRODSBURG, KY 40330-9219
(859) 324-5543
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
Primary
008544
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
008544
LICENSE NUMBER
KY
Enumeration date
02/20/2007
Last updated
07/08/2007
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