Provider Demographics
NPI:1730401837
Name:GROSSER, IRA PAUL (RPH)
Entity type:Individual
Prefix:MR
First Name:IRA
Middle Name:PAUL
Last Name:GROSSER
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 1:34 CHELMSFORD RD
Mailing Address - Street 2:
Mailing Address - City:ROCHESTER
Mailing Address - State:NY
Mailing Address - Zip Code:14618-1728
Mailing Address - Country:US
Mailing Address - Phone:585-473-7424
Mailing Address - Fax:
Practice Address - Street 1:1200 MARKETPLACE DR
Practice Address - Street 2:
Practice Address - City:ROCHESTER
Practice Address - State:NY
Practice Address - Zip Code:14623-6002
Practice Address - Country:US
Practice Address - Phone:585-292-0990
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-17
Last Update Date:2010-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY042229183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist