Provider Demographics
NPI:1891194809
Name:GROS, DANA M (RPH)
Entity type:Individual
Prefix:MRS
First Name:DANA
Middle Name:M
Last Name:GROS
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1633 MARTIN LUTHER KING JR BLVD
Mailing Address - Street 2:
Mailing Address - City:HOUMA
Mailing Address - State:LA
Mailing Address - Zip Code:70360-2897
Mailing Address - Country:US
Mailing Address - Phone:985-851-3284
Mailing Address - Fax:985-851-7593
Practice Address - Street 1:1633 MARTIN LUTHER KING JR BLVD
Practice Address - Street 2:
Practice Address - City:HOUMA
Practice Address - State:LA
Practice Address - Zip Code:70360-2897
Practice Address - Country:US
Practice Address - Phone:985-851-3284
Practice Address - Fax:985-851-7593
Is Sole Proprietor?:No
Enumeration Date:2014-08-14
Last Update Date:2014-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA017732183500000X
OH03122590183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist