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NPI Code Detail

MEDICARE: MR. SCOTT R GRIGAS

MEDICARE: MR. SCOTT R GRIGAS
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
1183500000XPharmacistPS0024863FL

General Provider Information

NPI Number : 1578845616
Entity Type Code : Individual
Provider Name (Legal Business Name) : MR. SCOTT R GRIGAS
Provider Business Mailing Address
First Line : 14964 LYMINGTON CIR
Second Line :
City : ORLANDO
State : FL
Zip : 32826-4103
Country : US
Telephone Number : 407-701-6484
Fax Number : 407-681-6359
Provider Business Practice Location Address
First Line : 3950 N DEAN RD
Second Line :
City : ORLANDO
State : FL
Zip : 32817-5144
Country : US
Telephone Number : 407-681-6366
Fax Number : 407-681-6359
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 09/14/2011
Last Update Date : 09/14/2011

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