Provider Demographics
NPI:1437758448
Name:GRUNDMANN, SCOTT JONATHAN (BS, PHARMD)
Entity Type:Individual
Prefix:
First Name:SCOTT
Middle Name:JONATHAN
Last Name:GRUNDMANN
Suffix:
Gender:M
Credentials:BS, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12450 MONTANA DR
Mailing Address - Street 2:
Mailing Address - City:FRISCO
Mailing Address - State:TX
Mailing Address - Zip Code:75035-0818
Mailing Address - Country:US
Mailing Address - Phone:214-668-9594
Mailing Address - Fax:
Practice Address - Street 1:1212 E BETHANY DR
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75002-5843
Practice Address - Country:US
Practice Address - Phone:972-727-9395
Practice Address - Fax:972-727-9072
Is Sole Proprietor?:No
Enumeration Date:2020-10-21
Last Update Date:2020-10-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX46525183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist