Healthcare Provider Details

I. General information

NPI: 1144738972
Provider Name (Legal Business Name): MARY ELIZABETH GRISNIK-KAUP PHARM D
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/15/2018
Last Update Date: 01/15/2018
Certification Date:
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: 724-458-4216
Mailing address:
  • Phone: 724-458-8420
  • Fax: 724-458-4216

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License NumberRP443829
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: