Provider Demographics
NPI:1942496898
Name:GRIMES, AMANDA (PHARM D)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:
Last Name:GRIMES
Suffix:
Gender:F
Credentials:PHARM D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1450 TINGLE CIR W
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36606-2632
Mailing Address - Country:US
Mailing Address - Phone:251-308-7040
Mailing Address - Fax:
Practice Address - Street 1:1450 TINGLE CIR W
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36606
Practice Address - Country:US
Practice Address - Phone:251-308-7040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-09-24
Last Update Date:2019-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26024876A183500000X
KY016198183500000X
AL15529183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist