Provider Demographics
NPI:1457931552
Name:GRIBBEN, MARIA ORALIA (PAHRMACY TECHNICIAN)
Entity Type:Individual
Prefix:
First Name:MARIA
Middle Name:ORALIA
Last Name:GRIBBEN
Suffix:
Gender:F
Credentials:PAHRMACY TECHNICIAN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:907 E 4TH ST
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76102-5531
Mailing Address - Country:US
Mailing Address - Phone:817-825-2251
Mailing Address - Fax:
Practice Address - Street 1:165 NW JOHN JONES DR
Practice Address - Street 2:
Practice Address - City:BURLESON
Practice Address - State:TX
Practice Address - Zip Code:76028-5154
Practice Address - Country:US
Practice Address - Phone:817-447-3213
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX102439183700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183700000XPharmacy Service ProvidersPharmacy Technician