Provider Demographics
NPI:1578966818
Name:GRUBBS, JOANNA (PHARMD)
Entity Type:Individual
Prefix:
First Name:JOANNA
Middle Name:
Last Name:GRUBBS
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:JOANNA
Other - Middle Name:
Other - Last Name:GRUBBS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:520 W LODI AVE
Mailing Address - Street 2:
Mailing Address - City:LODI
Mailing Address - State:CA
Mailing Address - Zip Code:95240-3425
Mailing Address - Country:US
Mailing Address - Phone:209-368-5363
Mailing Address - Fax:209-368-2702
Practice Address - Street 1:520 W LODI AVE
Practice Address - Street 2:
Practice Address - City:LODI
Practice Address - State:CA
Practice Address - Zip Code:95240-3425
Practice Address - Country:US
Practice Address - Phone:209-368-5363
Practice Address - Fax:209-368-2702
Is Sole Proprietor?:No
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA66857183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist