Healthcare Provider Details

I. General information

NPI: 1427281005
Provider Name (Legal Business Name): LEAH L GRYBOSKI BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/28/2009
Last Update Date: 08/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

360 WATERFRONT DR E
HOMESTEAD PA
15120-5004
US

IV. Provider business mailing address

360 WATERFRONT DR E
HOMESTEAD PA
15120-5004
US

V. Phone/Fax

Practice location:
  • Phone: 412-464-2323
  • Fax: 412-464-2623
Mailing address:
  • Phone: 412-464-2323
  • Fax: 412-464-2623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP039362L
License Number StatePA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: