Provider Demographics
NPI:1962497602
Name:GRIMMETT, ASHBY L JR (RPH)
Entity Type:Individual
Prefix:MR
First Name:ASHBY
Middle Name:L
Last Name:GRIMMETT
Suffix:JR
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 1:701 E 52ND ST
Mailing Address - Street 2:
Mailing Address - City:SAVANNAH
Mailing Address - State:GA
Mailing Address - Zip Code:31405-3603
Mailing Address - Country:US
Mailing Address - Phone:912-355-2136
Mailing Address - Fax:
Practice Address - Street 1:4 MEDICAL ARTS CTR
Practice Address - Street 2:
Practice Address - City:SAVANNAH
Practice Address - State:GA
Practice Address - Zip Code:31405-4415
Practice Address - Country:US
Practice Address - Phone:912-351-0047
Practice Address - Fax:912-351-0366
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-19
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA12146183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist