Provider Demographics
NPI:1578621116
Name:GRIMES, JOE (RPH)
Entity Type:Individual
Prefix:DR
First Name:JOE
Middle Name:
Last Name:GRIMES
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:206 BRIDGE ST
Mailing Address - Street 2:
Mailing Address - City:BELINGTON
Mailing Address - State:WV
Mailing Address - Zip Code:26250-9319
Mailing Address - Country:US
Mailing Address - Phone:304-823-1198
Mailing Address - Fax:
Practice Address - Street 1:206 BRIDGE ST
Practice Address - Street 2:
Practice Address - City:BELINGTON
Practice Address - State:WV
Practice Address - Zip Code:26250-9319
Practice Address - Country:US
Practice Address - Phone:304-823-1198
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-05
Last Update Date:2010-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVRP0006773183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WVRP0006773OtherBOARD OF PHARMACY