MEDICARE: HEATHER GRUNDY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	18559	NV

General Provider Information

NPI Number	:	1043645799
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	HEATHER GRUNDY

Provider Business Mailing Address
First Line	:	251 S GREEN VALLEY PKWY UNIT 921
Second Line	:
City	:	HENDERSON
State	:	NV
Zip	:	89012-2310
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5888 W SUNSET RD STE 200
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89118-3453
Country	:	US
Telephone Number	:	702-889-8274
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/12/2013
Last Update Date	:	09/12/2013

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Directions to “ HEATHER GRUNDY ” Practice Location

Language	Start Address	Practice Location

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