Healthcare Provider Details

I. General information

NPI: 1164524310
Provider Name (Legal Business Name): GRIFFS COMPOUNDING CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/01/2006
Last Update Date: 12/05/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3210 AVENUE B STE A
SCOTTSBLUFF NE
69361-4314
US

IV. Provider business mailing address

3210 AVENUE B STE A
SCOTTSBLUFF NE
69361-4314
US

V. Phone/Fax

Practice location:
  • Phone: 308-635-9800
  • Fax: 308-635-9899
Mailing address:
  • Phone: 308-635-9800
  • Fax: 308-635-9899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number3013
License Number StateNE

VIII. Authorized Official

Name: CLARK GRIFFITH
Title or Position: OWNER
Credential: BACHELOR
Phone: 308-635-9800