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General NPI Number Information
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NPI Number | 1164485702
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Entity Type | Organization
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Legal Business Name | GRIDER DRUG LLC
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Dates
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Enumeration Date | 04/06/2006
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Last Update Date | 03/26/2009
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Provider Practice Location Address
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Address Line | 124 DOWELL RD
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-4278
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Country | US
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Telephone | 270-866-2686
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Fax | 270-866-6566
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Provider Business Mailing Address
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Address Line | PO BOX 1328
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City | RUSSELL SPRINGS
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State | KY
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Zip | 42642-1328
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | PHARMACIST AND MANAGER
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Name | ERIC GRIDER
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Credential |
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Telephone | 270-866-2686
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 333600000X
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Taxonomy Name | Pharmacy
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 3336C0003X
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Taxonomy Name | Community/Retail Pharmacy
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License Number | P01425
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License Number State | KY
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