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General NPI Number Information
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NPI Number | 1619384112
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Entity Type | Organization
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Legal Business Name | TARGET STORES A DIV. OF TARGET CORP.
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Dates
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Enumeration Date | 07/16/2014
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Last Update Date | 07/16/2014
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Provider Practice Location Address
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Address Line | 10204 TWO NOTCH RD
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City | COLUMBIA
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State | SC
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Zip | 29229-4386
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Country | US
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Telephone | 803-788-0951
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Fax |
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Provider Business Mailing Address
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Address Line | 10204 TWO NOTCH RD
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City | COLUMBIA
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State | SC
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Zip | 29229-4386
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Country | US
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Telephone | 803-788-0951
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Fax |
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Authorized Official
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Title or Position | PHARMACIST
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Name | DR. RYAN GRIESBAUM
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Credential | PHARMD
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Telephone | 724-747-8567
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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 | 35644
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License Number State | SC
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