Provider Demographics
NPI:1750948543
Name:GRIERSON, CATHY
Entity type:Individual
Prefix:
First Name:CATHY
Middle Name:
Last Name:GRIERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2035 FOREST AVE
Mailing Address - Street 2:
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63139-3504
Mailing Address - Country:US
Mailing Address - Phone:614-370-8192
Mailing Address - Fax:
Practice Address - Street 1:134 W MORTON AVE
Practice Address - Street 2:
Practice Address - City:JACKSONVILLE
Practice Address - State:IL
Practice Address - Zip Code:62650-2811
Practice Address - Country:US
Practice Address - Phone:217-243-7818
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-05-28
Last Update Date:2019-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014024728183500000X
OH03331384183500000X
IL051299624183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist