Provider Demographics
NPI:1326684457
Name:GRIMAUDO, JAMES WILLIAM
Entity Type:Individual
Prefix:
First Name:JAMES
Middle Name:WILLIAM
Last Name:GRIMAUDO
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 1:2600 POINTE TREMBLE RD
Mailing Address - Street 2:
Mailing Address - City:ALGONAC
Mailing Address - State:MI
Mailing Address - Zip Code:48001-1684
Mailing Address - Country:US
Mailing Address - Phone:810-671-4002
Mailing Address - Fax:810-671-4004
Practice Address - Street 1:2600 POINTE TREMBLE RD
Practice Address - Street 2:
Practice Address - City:ALGONAC
Practice Address - State:MI
Practice Address - Zip Code:48001-1684
Practice Address - Country:US
Practice Address - Phone:810-671-4002
Practice Address - Fax:810-671-4004
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-25
Last Update Date:2019-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302027562183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist