Ray Gros
Individual provider Active NPI Pharmacist · Lakeside, CA
NPI 1942972203 · NPPES record last updated Oct 4, 2021
Key facts
- NPI
- 1942972203
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- RPH43143 (CA)
- Practice address
- 9943 Maine Ave
Lakeside, CA 92040-3107 - Phone
- (619) 443-1013
- Fax
- (619) 443-8517
- NPI assigned
- Oct 4, 2021
- Sex
- Male
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RPH43143 | CA | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | RPH43143 | CA | Yes |
Addresses
Primary practice location
9943 Maine Ave
Lakeside, CA 92040-3107
Mailing address
9943 Maine Ave
Lakeside, CA 92040-3107
Phone (619) 443-1013
Other providers in Lakeside, CA
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Oct 4, 2021. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.