Provider Demographics
NPI:1063799633
Name:GROENE, GARY THOMAS (RPH)
Entity type:Individual
Prefix:
First Name:GARY
Middle Name:THOMAS
Last Name:GROENE
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 1:406 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45202-0001
Mailing Address - Country:US
Mailing Address - Phone:513-721-0842
Mailing Address - Fax:513-721-2689
Practice Address - Street 1:406 MAIN ST
Practice Address - Street 2:
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45202-0001
Practice Address - Country:US
Practice Address - Phone:513-721-0842
Practice Address - Fax:513-721-2689
Is Sole Proprietor?:No
Enumeration Date:2011-11-10
Last Update Date:2011-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03120493183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist