Healthcare Provider Details

I. General information

NPI: 1043743917
Provider Name (Legal Business Name): JAMIE LAYNE GRUBB DOCTOR OF PHARMACY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/07/2017
Last Update Date: 04/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

551 MAIN ST N
MC KEE KY
40447-9082
US

IV. Provider business mailing address

238 JOHNSON RD
BEREA KY
40403-9609
US

V. Phone/Fax

Practice location:
  • Phone: 606-287-7187
  • Fax: 606-287-3646
Mailing address:
  • Phone: 859-893-4935
  • Fax: 606-287-3646

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number019055
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: