Provider Demographics
NPI:1457789794
Name:GRILLO, SANDRA J (BSPHARM, RPH, MBA)
Entity Type:Individual
Prefix:
First Name:SANDRA
Middle Name:J
Last Name:GRILLO
Suffix:
Gender:F
Credentials:BSPHARM, RPH, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:112 LAFAYETTE STREET
Mailing Address - Street 2:
Mailing Address - City:NORWICH
Mailing Address - State:CT
Mailing Address - Zip Code:06360
Mailing Address - Country:US
Mailing Address - Phone:860-887-2538
Mailing Address - Fax:860-886-1367
Practice Address - Street 1:112 LAFAYETTE STREET
Practice Address - Street 2:
Practice Address - City:NORWICH
Practice Address - State:CT
Practice Address - Zip Code:06360
Practice Address - Country:US
Practice Address - Phone:860-887-2538
Practice Address - Fax:860-886-1367
Is Sole Proprietor?:No
Enumeration Date:2013-10-24
Last Update Date:2013-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT6203183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist