Healthcare Provider Details

I. General information

NPI: 1861764128
Provider Name (Legal Business Name): PATRICK GRIFFITH BSPHARM
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2012
Last Update Date: 02/02/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

535 E BROADWAY
COUNCIL BLUFFS IA
51503-4419
US

IV. Provider business mailing address

13394 BLUEBIRD LN
COUNCIL BLUFFS IA
51503-5618
US

V. Phone/Fax

Practice location:
  • Phone: 712-329-0930
  • Fax: 712-329-0980
Mailing address:
  • Phone: 712-366-0886
  • Fax: 712-366-6449

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number13236
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: