Healthcare Provider Details

I. General information

NPI: 1790767671
Provider Name (Legal Business Name): DON GRUNTOWICZ PHARM.D., BCPS, CGP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/16/2005
Last Update Date: 02/27/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 WESTERN AVE STE 100 GENELEX CORPORATION
SEATTLE WA
98121-3017
US

IV. Provider business mailing address

3101 WESTERN AVE STE 100 GENELEX CORPORATION
SEATTLE WA
98121-3017
US

V. Phone/Fax

Practice location:
  • Phone: 206-302-8945
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License Number16474
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code1835P1200X
TaxonomyPharmacotherapy Pharmacist
License NumberPH60086614
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: