1912041336 NPI number — DR. AMY CHRISTINE GRIMSLEY PHARM.D.

Table of content: DR. AMY CHRISTINE GRIMSLEY PHARM.D. (NPI 1912041336)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1912041336 NPI number — DR. AMY CHRISTINE GRIMSLEY PHARM.D.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
GRIMSLEY
Provider First Name:
AMY
Provider Middle Name:
CHRISTINE
Provider Name Prefix Text:
DR.
Provider Name Suffix Text:
Provider Credential Text:
PHARM.D.
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
MITCHELL
Provider Other First Name:
AMY
Provider Other Middle Name:
CHRISTINE
Provider Other Name Prefix Text:
DR.
Provider Other Name Suffix Text:
Provider Other Credential Text:
PHARMD
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1912041336
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/04/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5204 TUCKERMAN LN
Provider Second Line Business Mailing Address:
APT 306
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20852-6639
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
478-461-0676
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
10 CENTER DR
Provider Second Line Business Practice Location Address:
RM 1C240 MSC 1196
Provider Business Practice Location Address City Name:
BETHESDA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20892-0001
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-435-0896
Provider Business Practice Location Address Fax Number:
301-496-0210
Provider Enumeration Date:
02/18/2007

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 183500000X , with the licence number:  RPH023166 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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