Healthcare Provider Details

I. General information

NPI: 1578966818
Provider Name (Legal Business Name): JOANNA GRUBBS PHARM.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JOANNA GRUBBS

II. Dates (important events)

Enumeration Date: 10/01/2014
Last Update Date: 10/01/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

520 W LODI AVE
LODI CA
95240-3425
US

IV. Provider business mailing address

520 W LODI AVE
LODI CA
95240-3425
US

V. Phone/Fax

Practice location:
  • Phone: 209-368-5363
  • Fax: 209-368-2702
Mailing address:
  • Phone: 209-368-5363
  • Fax: 209-368-2702

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number66857
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: