Provider Demographics
NPI:1922631035
Name:GRIMES, BENJAMIN THOMPSON (PHARMD)
Entity Type:Individual
Prefix:
First Name:BENJAMIN
Middle Name:THOMPSON
Last Name:GRIMES
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3094 WATSON BLVD
Mailing Address - Street 2:
Mailing Address - City:WARNER ROBINS
Mailing Address - State:GA
Mailing Address - Zip Code:31093-8500
Mailing Address - Country:US
Mailing Address - Phone:478-971-2341
Mailing Address - Fax:478-971-2345
Practice Address - Street 1:3094 WATSON BLVD
Practice Address - Street 2:
Practice Address - City:WARNER ROBINS
Practice Address - State:GA
Practice Address - Zip Code:31093-8500
Practice Address - Country:US
Practice Address - Phone:478-971-2341
Practice Address - Fax:478-971-2345
Is Sole Proprietor?:No
Enumeration Date:2020-02-17
Last Update Date:2020-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA0221171835P0018X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835P0018XPharmacy Service ProvidersPharmacistPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist