Healthcare Provider Details

I. General information

NPI: 1194642579
Provider Name (Legal Business Name): GRACE GRILLO
Entity Type: Individual
Gender:
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/06/2026
Last Update Date: 07/06/2026
Certification Date: 07/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1050 RIDGE RD
WEBSTER NY
14580-2908
US

IV. Provider business mailing address

1676 PENFIELD RD
ROCHESTER NY
14625-2559
US

V. Phone/Fax

Practice location:
  • Phone: 585-216-3001
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number073988
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: