Provider Demographics
NPI:1225714132
Name:MCNAMARA, GRIFFIN
Entity Type:Individual
Prefix:
First Name:GRIFFIN
Middle Name:
Last Name:MCNAMARA
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 ILLINI BLVD
Mailing Address - Street 2:
Mailing Address - City:SHERMAN
Mailing Address - State:IL
Mailing Address - Zip Code:62684
Mailing Address - Country:US
Mailing Address - Phone:217-496-2392
Mailing Address - Fax:
Practice Address - Street 1:106 ILLINI BLVD
Practice Address - Street 2:
Practice Address - City:SHERMAN
Practice Address - State:IL
Practice Address - Zip Code:62684
Practice Address - Country:US
Practice Address - Phone:217-496-2392
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.301125183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist