MEDICARE: DAWN GRINSTEAD CPHT

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	183700000X	Pharmacy Technician	PT00001077	WV

General Provider Information

NPI Number	:	1083064240
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DAWN GRINSTEAD CPHT

Provider Business Mailing Address
First Line	:	4016 OHIO RIVER RD
Second Line	:
City	:	POINT PLEASANT
State	:	WV
Zip	:	25550-3257
Country	:	US
Telephone Number	:	304-675-1612
Fax Number	:	304-675-7338

Provider Business Practice Location Address
First Line	:	4016 OHIO RIVER RD
Second Line	:
City	:	POINT PLEASANT
State	:	WV
Zip	:	25550-3257
Country	:	US
Telephone Number	:	304-675-1612
Fax Number	:	304-675-7338

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

Provider Enumeration Date	:	06/20/2016
Last Update Date	:	06/20/2016

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