Provider Demographics
NPI:1407036569
Name:GRISKO, KAREN E (RPH)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:E
Last Name:GRISKO
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10357 TILLMAN RD
Mailing Address - Street 2:
Mailing Address - City:CLARENCE
Mailing Address - State:NY
Mailing Address - Zip Code:14031-2320
Mailing Address - Country:US
Mailing Address - Phone:716-759-1424
Mailing Address - Fax:
Practice Address - Street 1:153 PROSPECT ST
Practice Address - Street 2:
Practice Address - City:ATTICA
Practice Address - State:NY
Practice Address - Zip Code:14011-1149
Practice Address - Country:US
Practice Address - Phone:585-591-0945
Practice Address - Fax:585-591-3019
Is Sole Proprietor?:No
Enumeration Date:2007-11-06
Last Update Date:2007-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY043071183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist