Provider Demographics
NPI:1306217393
Name:GRIMALDI, MICHAEL J (RPH)
Entity Type:Individual
Prefix:
First Name:MICHAEL
Middle Name:J
Last Name:GRIMALDI
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 1:170 ROLLING HILLS DR
Mailing Address - Street 2:
Mailing Address - City:FAIRFIELD
Mailing Address - State:CT
Mailing Address - Zip Code:06824-1866
Mailing Address - Country:US
Mailing Address - Phone:203-261-9556
Mailing Address - Fax:
Practice Address - Street 1:189 MAIN ST
Practice Address - Street 2:
Practice Address - City:NORWALK
Practice Address - State:CT
Practice Address - Zip Code:06851-3607
Practice Address - Country:US
Practice Address - Phone:203-845-0616
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-10-15
Last Update Date:2015-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT50891835P2201X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P2201XPharmacy Service ProvidersPharmacistAmbulatory Care