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General NPI Number Information
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NPI Number | 1780288654
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Entity Type | Individual
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Provider Name | IVAN EVERETTE GRIGGS PHARM.D.
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Gender | Male
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Dates
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Enumeration Date | 11/22/2020
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Last Update Date | 11/22/2020
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Provider Practice Location Address
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Address Line | 13711 S TAMIAMI TRL
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City | FORT MYERS
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State | FL
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Zip | 33912-1649
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Country | US
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Telephone | 850-305-1293
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Fax |
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Provider Business Mailing Address
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Address Line | 4903 EDITH ESPLANADE
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City | CAPE CORAL
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State | FL
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Zip | 33904-5617
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Country | US
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Telephone | 850-305-1293
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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 | 333600000X
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Taxonomy Name | Pharmacy
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License Number | PS57639
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License Number State | FL
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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 | PS57639
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License Number State | FL
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