Provider Demographics
NPI:1891809562
Name:VINCENT, GRIFFITH LEE (RPH)
Entity Type:Individual
Prefix:MR
First Name:GRIFFITH
Middle Name:LEE
Last Name:VINCENT
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 1:13980 STATE ROUTE 56 SE
Mailing Address - Street 2:
Mailing Address - City:MT. STERLING
Mailing Address - State:OH
Mailing Address - Zip Code:43143
Mailing Address - Country:US
Mailing Address - Phone:740-869-4289
Mailing Address - Fax:740-869-3784
Practice Address - Street 1:283 YANKEETOWN RD.
Practice Address - Street 2:
Practice Address - City:MOUNT STERLING
Practice Address - State:OH
Practice Address - Zip Code:43143
Practice Address - Country:US
Practice Address - Phone:740-869-3784
Practice Address - Fax:740-869-3840
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-18
Last Update Date:2008-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH3336C0003X183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
GRFV94281Medicare PIN