Provider Demographics
NPI:1114269107
Name:GRICE, JONATHAN ALLEN (PHARM D)
Entity Type:Individual
Prefix:DR
First Name:JONATHAN
Middle Name:ALLEN
Last Name:GRICE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 884
Mailing Address - Street 2:
Mailing Address - City:NEWAYGO
Mailing Address - State:MI
Mailing Address - Zip Code:49337-0884
Mailing Address - Country:US
Mailing Address - Phone:231-742-1259
Mailing Address - Fax:231-861-6933
Practice Address - Street 1:60 E 82ND ST
Practice Address - Street 2:
Practice Address - City:NEWAYGO
Practice Address - State:MI
Practice Address - Zip Code:49337-8005
Practice Address - Country:US
Practice Address - Phone:231-742-1259
Practice Address - Fax:231-861-6933
Is Sole Proprietor?:Yes
Enumeration Date:2013-03-18
Last Update Date:2013-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302036136183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist