Provider Demographics
NPI:1235461807
Name:GRIFFIN, JOSEPHINE CARMELA
Entity Type:Individual
Prefix:
First Name:JOSEPHINE
Middle Name:CARMELA
Last Name:GRIFFIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:190 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:NEW PALTZ
Mailing Address - State:NY
Mailing Address - Zip Code:12561-1211
Mailing Address - Country:US
Mailing Address - Phone:845-255-0310
Mailing Address - Fax:845-255-0576
Practice Address - Street 1:190 MAIN ST
Practice Address - Street 2:
Practice Address - City:NEW PALTZ
Practice Address - State:NY
Practice Address - Zip Code:12561-1211
Practice Address - Country:US
Practice Address - Phone:845-255-0310
Practice Address - Fax:845-255-0576
Is Sole Proprietor?:No
Enumeration Date:2010-02-08
Last Update Date:2010-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY049290183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist