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NPI Code Detail

MEDICARE: JACK B. GRIDER PHARM,D.

MEDICARE: JACK B. GRIDER PHARM,D.
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
1183500000XPharmacistRPH 37866CA

General Provider Information

NPI Number : 1891834826
Entity Type Code : Individual
Provider Name (Legal Business Name) : JACK B. GRIDER PHARM,D.
Provider Business Mailing Address
First Line : 4540 GNEKOW DR
Second Line :
City : STOCKTON
State : CA
Zip : 95212-1307
Country : US
Telephone Number : 209-931-0805
Fax Number : 209-931-0809
Provider Business Practice Location Address
First Line : 711 E MARKET ST
Second Line :
City : STOCKTON
State : CA
Zip : 95202-3104
Country : US
Telephone Number : 209-373-7559
Fax Number : 209-462-0475
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/06/2007
Last Update Date : 07/08/2007

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Directions to “ JACK B. GRIDER PHARM,D.” Practice Location

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