Provider Demographics
NPI:1265561393
Name:GRENIER, RITA D (RPH)
Entity type:Individual
Prefix:MRS
First Name:RITA
Middle Name:D
Last Name:GRENIER
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:PO BOX 772481
Mailing Address - Street 2:
Mailing Address - City:EAGLE RIVER
Mailing Address - State:AK
Mailing Address - Zip Code:99577-2481
Mailing Address - Country:US
Mailing Address - Phone:907-762-0204
Mailing Address - Fax:907-762-0293
Practice Address - Street 1:4900 EAGLE ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-7446
Practice Address - Country:US
Practice Address - Phone:907-762-0204
Practice Address - Fax:907-762-0293
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK6821835G0303X
OR65741835G0303X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1835G0303XPharmacy Service ProvidersPharmacistGeriatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR6574OtherPHARMACIST LICENSE
CA33046OtherPHARMACIST LICENSE
AK682OtherPHARMACIST LICENSE