Provider Demographics
NPI:1528109980
Name:GRUICH, FRANK GEORGE JR
Entity type:Individual
Prefix:MR
First Name:FRANK
Middle Name:GEORGE
Last Name:GRUICH
Suffix:JR
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2430 BONNE TERRE BLVD
Mailing Address - Street 2:
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39531-2280
Mailing Address - Country:US
Mailing Address - Phone:228-388-9849
Mailing Address - Fax:
Practice Address - Street 1:2430 BONNE TERRE BLVD
Practice Address - Street 2:
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39531-2280
Practice Address - Country:US
Practice Address - Phone:228-388-9849
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSE06035183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist