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General NPI Number Information
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NPI Number | 1487961199
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Entity Type | Individual
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Provider Name | MARSHALL JOHN GRIGNON PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 09/02/2010
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Last Update Date | 09/02/2010
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Provider Practice Location Address
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Address Line | 522 W ONONDAGA ST
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City | SYRACUSE
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State | NY
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Zip | 13204-3225
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Country | US
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Telephone | 315-475-1366
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Fax |
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Provider Business Mailing Address
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Address Line | 3396 HAMMOCKS DR APARTMENT 208
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City | BALDWINSVILLE
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State | NY
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Zip | 13027-4252
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Country | US
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Telephone | 518-368-3686
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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 | 054625
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License Number State | NY
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