Provider Demographics
NPI:1033353784
Name:GRUBB, DAVE B
Entity Type:Individual
Prefix:MR
First Name:DAVE
Middle Name:B
Last Name:GRUBB
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:DAVE
Other - Middle Name:B
Other - Last Name:GRUBB
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:REGISTERED PHARMACIS
Mailing Address - Street 1:4714 N LINCOLN RD
Mailing Address - Street 2:
Mailing Address - City:LUDINGTON
Mailing Address - State:MI
Mailing Address - Zip Code:49431-9436
Mailing Address - Country:US
Mailing Address - Phone:231-843-7566
Mailing Address - Fax:
Practice Address - Street 1:3263 COLBY RD
Practice Address - Street 2:
Practice Address - City:WHITEHALL
Practice Address - State:MI
Practice Address - Zip Code:49461-9637
Practice Address - Country:US
Practice Address - Phone:231-893-0310
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-04-25
Last Update Date:2009-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302410831183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist