Provider Demographics
NPI:1811204720
Name:GRIGG, DANETTE MARIE (RPH)
Entity Type:Individual
Prefix:MRS
First Name:DANETTE
Middle Name:MARIE
Last Name:GRIGG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1276 W RIVER ST
Mailing Address - Street 2:SUITE 138
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83702-7066
Mailing Address - Country:US
Mailing Address - Phone:208-576-4500
Mailing Address - Fax:208-488-6646
Practice Address - Street 1:1276 W RIVER ST
Practice Address - Street 2:SUITE 138
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-7066
Practice Address - Country:US
Practice Address - Phone:208-576-4500
Practice Address - Fax:208-488-6646
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-13
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDP5301183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist