Provider Demographics
NPI:1164524310
Name:GRIFFS COMPOUNDING CENTER INC
Entity Type:Organization
Organization Name:GRIFFS COMPOUNDING CENTER INC
Other - Org Name:GRIFFS COMPOUNDING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CLARK
Authorized Official - Middle Name:
Authorized Official - Last Name:GRIFFITH
Authorized Official - Suffix:
Authorized Official - Credentials:BACHELOR
Authorized Official - Phone:308-635-9800
Mailing Address - Street 1:3210 AVENUE B STE A
Mailing Address - Street 2:
Mailing Address - City:SCOTTSBLUFF
Mailing Address - State:NE
Mailing Address - Zip Code:69361-4314
Mailing Address - Country:US
Mailing Address - Phone:308-635-9800
Mailing Address - Fax:308-635-9899
Practice Address - Street 1:3210 AVENUE B STE A
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-4314
Practice Address - Country:US
Practice Address - Phone:308-635-9800
Practice Address - Fax:308-635-9899
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-01
Last Update Date:2016-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
333600000X, 3336C0003X
NE30133336C0004X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3336C0004XSuppliersPharmacyCompounding Pharmacy
No333600000XSuppliersPharmacy
No3336C0003XSuppliersPharmacyCommunity/Retail Pharmacy
Provider Identifiers
StateIdentifier IDID TypeIssuer
2055907OtherPK