Provider Demographics
NPI:1679856652
Name:GRILL, JAMIE
Entity Type:Individual
Prefix:MRS
First Name:JAMIE
Middle Name:
Last Name:GRILL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10678 OLD HAMMOCK WAY
Mailing Address - Street 2:
Mailing Address - City:WELLINGTON
Mailing Address - State:FL
Mailing Address - Zip Code:33414-3148
Mailing Address - Country:US
Mailing Address - Phone:561-798-3172
Mailing Address - Fax:
Practice Address - Street 1:10678 OLD HAMMOCK WAY
Practice Address - Street 2:
Practice Address - City:WELLINGTON
Practice Address - State:FL
Practice Address - Zip Code:33414-3148
Practice Address - Country:US
Practice Address - Phone:561-798-3172
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-26
Last Update Date:2011-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPS37995183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist