Provider Demographics
NPI:1750792370
Name:GRUNENBERG, CONNIE LYNN (RN,RPH)
Entity type:Individual
Prefix:MS
First Name:CONNIE
Middle Name:LYNN
Last Name:GRUNENBERG
Suffix:
Gender:F
Credentials:RN,RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1082 STATE ROUTE 28
Mailing Address - Street 2:
Mailing Address - City:MILFORD
Mailing Address - State:OH
Mailing Address - Zip Code:45150-4933
Mailing Address - Country:US
Mailing Address - Phone:513-576-5520
Mailing Address - Fax:513-576-5565
Practice Address - Street 1:1082 STATE ROUTE 28
Practice Address - Street 2:
Practice Address - City:MILFORD
Practice Address - State:OH
Practice Address - Zip Code:45150-4933
Practice Address - Country:US
Practice Address - Phone:513-576-5520
Practice Address - Fax:513-576-5565
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-16
Last Update Date:2014-05-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03223736183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist