Provider Demographics
NPI:1306968334
Name:GROSS, ROBERT JESS (RPH)
Entity type:Individual
Prefix:MR
First Name:ROBERT
Middle Name:JESS
Last Name:GROSS
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 1:157 GROSS LANE
Mailing Address - Street 2:
Mailing Address - City:LAFOLLETTE
Mailing Address - State:TN
Mailing Address - Zip Code:37766
Mailing Address - Country:US
Mailing Address - Phone:423-566-0654
Mailing Address - Fax:
Practice Address - Street 1:901 E CENTRAL AVE
Practice Address - Street 2:MEDICAL CENTER PHARMACY
Practice Address - City:LAFOLLETTE
Practice Address - State:TN
Practice Address - Zip Code:37766
Practice Address - Country:US
Practice Address - Phone:423-562-8456
Practice Address - Fax:423-562-3167
Is Sole Proprietor?:No
Enumeration Date:2007-04-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5346183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist