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NPI Code Detail

MEDICARE: MARILEY M GRINDELL

MEDICARE: MARILEY M GRINDELL
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1183500000XPharmacist47251TX

General Provider Information

NPI Number : 1902407885
Entity Type Code : Individual
Provider Name (Legal Business Name) : MARILEY M GRINDELL
Provider Business Mailing Address
First Line : 1217 GREENWOOD DR
Second Line :
City : HURST
State : TX
Zip : 76053-5323
Country : US
Telephone Number : 817-449-3935
Fax Number :
Provider Business Practice Location Address
First Line : 2245 JACKSBORO HWY
Second Line :
City : FORT WORTH
State : TX
Zip : 76114-2319
Country : US
Telephone Number : 817-569-6241
Fax Number : 817-569-6242
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/05/2020
Last Update Date : 11/05/2020

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Directions to “ MARILEY M GRINDELL ” Practice Location

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