Provider Demographics
NPI:1669201711
Name:GRISETTI, MARK HILPERT (RPH)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:HILPERT
Last Name:GRISETTI
Suffix:
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 1:786 LOVELY RD
Mailing Address - Street 2:
Mailing Address - City:ALUM BANK
Mailing Address - State:PA
Mailing Address - Zip Code:15521-9046
Mailing Address - Country:US
Mailing Address - Phone:814-276-3377
Mailing Address - Fax:
Practice Address - Street 1:PO BOX 346
Practice Address - Street 2:
Practice Address - City:BEDFORD
Practice Address - State:PA
Practice Address - Zip Code:15522-0346
Practice Address - Country:US
Practice Address - Phone:814-623-5512
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP003563L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist