Provider Demographics
NPI:1689003337
Name:GRILLIOT, BENJAMIN LEO (RPH)
Entity Type:Individual
Prefix:MR
First Name:BENJAMIN
Middle Name:LEO
Last Name:GRILLIOT
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 1:233 GRANT ST
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:OH
Mailing Address - Zip Code:45373-3117
Mailing Address - Country:US
Mailing Address - Phone:937-307-0904
Mailing Address - Fax:
Practice Address - Street 1:233 GRANT ST
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:OH
Practice Address - Zip Code:45373-3117
Practice Address - Country:US
Practice Address - Phone:937-307-0904
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-04
Last Update Date:2013-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH032236061835P1200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P1200XPharmacy Service ProvidersPharmacistPharmacotherapy