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General NPI Number Information
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NPI Number | 1043566276
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Entity Type | Individual
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Provider Name | NATHAN MICHAEL GREMILLION PHARMD
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Gender | Male
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Dates
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Enumeration Date | 07/25/2012
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Last Update Date | 07/25/2012
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Provider Practice Location Address
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Address Line | 432 N MAIN ST
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City | ALTURAS
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State | CA
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Zip | 96101-3458
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Country | US
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Telephone | 530-233-3113
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Fax |
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Provider Business Mailing Address
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Address Line | 104 N EAST ST
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City | ALTURAS
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State | CA
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Zip | 96101-4032
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Country | US
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Telephone | 801-326-9508
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Fax |
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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 | 67017
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License Number State | CA
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