Provider Demographics
NPI:1558610378
Name:GRILLEY, KATIE LYNN (PHARMD)
Entity type:Individual
Prefix:
First Name:KATIE
Middle Name:LYNN
Last Name:GRILLEY
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:KATIE
Other - Middle Name:LYNN
Other - Last Name:HATTEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHARMD
Mailing Address - Street 1:619 MOUNTAIN VIEW DR
Mailing Address - Street 2:
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-6699
Mailing Address - Country:US
Mailing Address - Phone:406-249-6487
Mailing Address - Fax:
Practice Address - Street 1:200 CONWAY DR
Practice Address - Street 2:
Practice Address - City:KALISPELL
Practice Address - State:MT
Practice Address - Zip Code:59901-3112
Practice Address - Country:US
Practice Address - Phone:406-751-7600
Practice Address - Fax:406-257-5230
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-07
Last Update Date:2025-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MTPHA-PHA-LIC-12408183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist