Provider Demographics
NPI:1396358750
Name:GRIMES, ANNIE (PHARMD)
Entity Type:Individual
Prefix:
First Name:ANNIE
Middle Name:
Last Name:GRIMES
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 1:700 N JACKSON ST
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-3544
Mailing Address - Country:US
Mailing Address - Phone:931-455-6778
Mailing Address - Fax:931-461-1281
Practice Address - Street 1:700 N JACKSON ST
Practice Address - Street 2:
Practice Address - City:TULLAHOMA
Practice Address - State:TN
Practice Address - Zip Code:37388-3544
Practice Address - Country:US
Practice Address - Phone:931-455-6778
Practice Address - Fax:931-461-1281
Is Sole Proprietor?:No
Enumeration Date:2020-08-26
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN38628183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist