Provider Demographics
NPI:1811202518
Name:GRINBERG, ETTI (RPH)
Entity type:Individual
Prefix:MRS
First Name:ETTI
Middle Name:
Last Name:GRINBERG
Suffix:
Gender:F
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 HICKORY WAY
Mailing Address - Street 2:
Mailing Address - City:SHARON
Mailing Address - State:MA
Mailing Address - Zip Code:02067-2355
Mailing Address - Country:US
Mailing Address - Phone:781-784-0650
Mailing Address - Fax:
Practice Address - Street 1:175 DEAN ST
Practice Address - Street 2:
Practice Address - City:TAUNTON
Practice Address - State:MA
Practice Address - Zip Code:02780-2718
Practice Address - Country:US
Practice Address - Phone:508-823-5270
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-08-18
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPH24951183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist