Healthcare Provider Details

I. General information

NPI: 1356405997
Provider Name (Legal Business Name): BETTY L. GRINDE R.PH.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 BROAD ST
STORY CITY IA
50248-1200
US

IV. Provider business mailing address

621 BROAD ST
STORY CITY IA
50248-1200
US

V. Phone/Fax

Practice location:
  • Phone: 515-733-2233
  • Fax: 515-733-2366
Mailing address:
  • Phone: 515-733-2233
  • Fax: 515-733-2366

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number15568
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: