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General NPI Number Information
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NPI Number | 1386920890
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Entity Type | Individual
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Provider Name | PAMELA JO GRIMSLID RPH
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Gender | Female
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Dates
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Enumeration Date | 10/28/2011
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Last Update Date | 10/28/2011
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Provider Practice Location Address
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Address Line | 101 E SANDUSKY AVE
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City | BELLEFONTAINE
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State | OH
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Zip | 43311-2016
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Country | US
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Telephone | 937-292-8104
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Fax |
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Provider Business Mailing Address
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Address Line | 509 W NORTH AVE
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City | ADA
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State | OH
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Zip | 45810-1077
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Country | US
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Telephone | 419-634-9888
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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 | 03312980
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License Number State | OH
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