Healthcare Provider Details

I. General information

NPI: 1063057016
Provider Name (Legal Business Name): JENNA ALEXIS GRIMM PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/14/2019
Last Update Date: 11/14/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1341 WRIGHT AVE
ALMA MI
48801-1134
US

IV. Provider business mailing address

1200 S WASHINGTON ST RM 112
MT PLEASANT MI
48858-4203
US

V. Phone/Fax

Practice location:
  • Phone: 989-463-6111
  • Fax:
Mailing address:
  • Phone: 616-405-2043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302411878
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: