Provider Demographics
NPI:1710161492
Name:GRIMALDI, DOMINICK (RPH)
Entity Type:Individual
Prefix:MR
First Name:DOMINICK
Middle Name:
Last Name:GRIMALDI
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 1:94 REIDS HILL RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NJ
Mailing Address - Zip Code:07747-1883
Mailing Address - Country:US
Mailing Address - Phone:732-673-3782
Mailing Address - Fax:
Practice Address - Street 1:94 REIDS HILL RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NJ
Practice Address - Zip Code:07747-1883
Practice Address - Country:US
Practice Address - Phone:732-673-3782
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-12-18
Last Update Date:2007-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY31675183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist