Provider Demographics
NPI:1003926502
Name:GRIEBS DARIEN PHARMACY INC.
Entity Type:Organization
Organization Name:GRIEBS DARIEN PHARMACY INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CHUCK
Authorized Official - Middle Name:
Authorized Official - Last Name:HIBBEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:203-655-1000
Mailing Address - Street 1:1021 POST RD
Mailing Address - Street 2:
Mailing Address - City:DARIEN
Mailing Address - State:CT
Mailing Address - Zip Code:06820-4510
Mailing Address - Country:US
Mailing Address - Phone:203-655-1000
Mailing Address - Fax:203-656-0172
Practice Address - Street 1:1021 POST RD
Practice Address - Street 2:
Practice Address - City:DARIEN
Practice Address - State:CT
Practice Address - Zip Code:06820-4510
Practice Address - Country:US
Practice Address - Phone:203-655-1000
Practice Address - Fax:203-656-0172
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-30
Last Update Date:2016-10-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT1183336C0003X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT940004026431Medicaid