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General NPI Number Information
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NPI Number | 1013329119
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Entity Type | Individual
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Provider Name | MR. WILLARD GRUBB
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Gender | Male
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 05/22/2014
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Provider Practice Location Address
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Address Line | 6610 S SCATTERFIELD RD
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City | ANDERSON
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State | IN
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Zip | 46013-9605
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Country | US
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Telephone | 765-683-5233
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Fax | 765-683-5265
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Provider Business Mailing Address
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Address Line | 2132 W 1300 N
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City | ALEXANDRIA
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State | IN
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Zip | 46001-8510
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Country | US
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Telephone | 765-754-8927
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Fax | 765-683-5265
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 183500000X
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Taxonomy Name | Pharmacist
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License Number | 26013318A
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License Number State | IN
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