Healthcare Provider Details

I. General information

NPI: 1780448795
Provider Name (Legal Business Name): PAMELA LEE GRISNIK
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: PAMELA LEE BURNS

II. Dates (important events)

Enumeration Date: 02/09/2024
Last Update Date: 02/09/2024
Certification Date: 02/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

111 MILL ST
GROVE CITY PA
16127-1514
US

IV. Provider business mailing address

111 MILL ST
GROVE CITY PA
16127-1514
US

V. Phone/Fax

Practice location:
  • Phone: 724-458-8420
  • Fax:
Mailing address:
  • Phone: 724-458-8420
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP032246L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: