Provider Demographics
NPI:1780448795
Name:GRISNIK, PAMELA LEE
Entity type:Individual
Prefix:
First Name:PAMELA
Middle Name:LEE
Last Name:GRISNIK
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:PAMELA
Other - Middle Name:LEE
Other - Last Name:BURNS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:111 MILL ST
Mailing Address - Street 2:
Mailing Address - City:GROVE CITY
Mailing Address - State:PA
Mailing Address - Zip Code:16127-1514
Mailing Address - Country:US
Mailing Address - Phone:724-458-8420
Mailing Address - Fax:
Practice Address - Street 1:111 MILL ST
Practice Address - Street 2:
Practice Address - City:GROVE CITY
Practice Address - State:PA
Practice Address - Zip Code:16127-1514
Practice Address - Country:US
Practice Address - Phone:724-458-8420
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-09
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP032246L183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist