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General NPI Number Information
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NPI Number | 1184316069
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Entity Type | Individual
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Provider Name | NICHOLAS GRILLO
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Gender | Male
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Dates
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Enumeration Date | 05/22/2023
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Last Update Date | 10/23/2024
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Provider Practice Location Address
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Address Line | 51 N 39TH ST
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City | PHILADELPHIA
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State | PA
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Zip | 19104-2640
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Country | US
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Telephone | 609-828-8802
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Fax |
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Provider Business Mailing Address
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Address Line | 128 FOX CHASE LN
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City | CHERRY HILL
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State | NJ
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Zip | 08034-2804
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Country | US
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Telephone | 609-828-8802
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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 | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | 28RI04314300
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License Number State | NJ
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Taxonomy #2
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 1835P2201X
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Taxonomy Name | Ambulatory Care Pharmacist
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License Number | RP458486
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License Number State | PA
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