Provider Demographics
NPI:1417426198
Name:GRISSETT, MARY PEYTON
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:PEYTON
Last Name:GRISSETT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:MARY
Other - Middle Name:PEYTON
Other - Last Name:GILBERT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10640 COLFAX DR
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75072-6113
Mailing Address - Country:US
Mailing Address - Phone:334-208-6105
Mailing Address - Fax:
Practice Address - Street 1:10640 COLFAX DR
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75072-6113
Practice Address - Country:US
Practice Address - Phone:334-208-6105
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-25
Last Update Date:2018-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX273957183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician