Provider Demographics
NPI:1235307976
Name:GRISE, WILLIAM M (PHARM D)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:M
Last Name:GRISE
Suffix:
Gender:M
Credentials:PHARM D
Other - Prefix:DR
Other - First Name:WILLAIM
Other - Middle Name:M
Other - Last Name:GRISE
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHARM D
Mailing Address - Street 1:1278 MILLER DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3022
Mailing Address - Country:US
Mailing Address - Phone:859-624-1843
Mailing Address - Fax:
Practice Address - Street 1:1278 MILLER DR
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3022
Practice Address - Country:US
Practice Address - Phone:859-624-1843
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-02-15
Last Update Date:2008-02-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY008891183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist