Provider Demographics
NPI:1013365253
Name:GRENKA, KATHY
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:GRENKA
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3800 OAKWOOD BLVD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:FL
Mailing Address - Zip Code:33020-7114
Mailing Address - Country:US
Mailing Address - Phone:954-922-7845
Mailing Address - Fax:847-396-2709
Practice Address - Street 1:3800 OAKWOOD BLVD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:FL
Practice Address - Zip Code:33020-7114
Practice Address - Country:US
Practice Address - Phone:954-922-7845
Practice Address - Fax:847-396-2709
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2016-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS39829183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist