Provider Demographics
NPI:1124361332
Name:GRIGG, STANLEY W (RPH)
Entity Type:Individual
Prefix:MR
First Name:STANLEY
Middle Name:W
Last Name:GRIGG
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:128 S TOWNSEND AVE
Mailing Address - Street 2:
Mailing Address - City:MONTROSE
Mailing Address - State:CO
Mailing Address - Zip Code:81401-3988
Mailing Address - Country:US
Mailing Address - Phone:970-249-2064
Mailing Address - Fax:970-249-7720
Practice Address - Street 1:128 S TOWNSEND AVE
Practice Address - Street 2:
Practice Address - City:MONTROSE
Practice Address - State:CO
Practice Address - Zip Code:81401-3988
Practice Address - Country:US
Practice Address - Phone:970-249-2064
Practice Address - Fax:970-249-7720
Is Sole Proprietor?:No
Enumeration Date:2013-04-05
Last Update Date:2013-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9994183500000X
KS1-09276183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist