Provider Demographics
NPI:1316541949
Name:GRUNLOH, AUDREY (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:AUDREY
Middle Name:
Last Name:GRUNLOH
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:221 N BROADWAY AVE STE 100
Mailing Address - Street 2:
Mailing Address - City:URBANA
Mailing Address - State:IL
Mailing Address - Zip Code:61801-2748
Mailing Address - Country:US
Mailing Address - Phone:217-383-8700
Mailing Address - Fax:
Practice Address - Street 1:221 N BROADWAY AVE STE 100
Practice Address - Street 2:
Practice Address - City:URBANA
Practice Address - State:IL
Practice Address - Zip Code:61801-2748
Practice Address - Country:US
Practice Address - Phone:217-383-8700
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-24
Last Update Date:2023-10-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051.297043183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist