Provider Demographics
NPI:1659706059
Name:GRUBB, LORI JANE (PHARMD)
Entity Type:Individual
Prefix:DR
First Name:LORI
Middle Name:JANE
Last Name:GRUBB
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-1813
Mailing Address - Country:US
Mailing Address - Phone:336-495-2380
Mailing Address - Fax:336-498-9363
Practice Address - Street 1:215 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RANDLEMAN
Practice Address - State:NC
Practice Address - Zip Code:27317-1813
Practice Address - Country:US
Practice Address - Phone:336-495-2380
Practice Address - Fax:336-498-9363
Is Sole Proprietor?:No
Enumeration Date:2013-09-05
Last Update Date:2013-09-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC15648183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist