=====================================================
General NPI Number Information
=====================================================
NPI Number | 1912041336
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | AMY CHRISTINE GRIMSLEY PHARM.D.
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 02/18/2007
-----------------------------------------------------
Last Update Date | 04/04/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10 CENTER DR RM 1C240 MSC 1196
-----------------------------------------------------
City | BETHESDA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20892-0001
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-435-0896
-----------------------------------------------------
Fax | 301-496-0210
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5204 TUCKERMAN LN APT 306
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20852-6639
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 478-461-0676
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 183500000X
-----------------------------------------------------
Taxonomy Name | Pharmacist
-----------------------------------------------------
License Number | RPH023166
-----------------------------------------------------
License Number State | GA
-----------------------------------------------------