Provider Demographics
NPI:1831512813
Name:GRIMES, JERI DANIELLE (RPH, PHARMD)
Entity type:Individual
Prefix:DR
First Name:JERI
Middle Name:DANIELLE
Last Name:GRIMES
Suffix:
Gender:F
Credentials:RPH, PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:523 RIVER RD
Mailing Address - Street 2:
Mailing Address - City:SNEEDVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37869-3809
Mailing Address - Country:US
Mailing Address - Phone:423-418-8091
Mailing Address - Fax:
Practice Address - Street 1:4331 HIGHWAY 66 S
Practice Address - Street 2:
Practice Address - City:ROGERSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37857-3145
Practice Address - Country:US
Practice Address - Phone:423-272-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-01-28
Last Update Date:2014-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000036280183500000X
IN26021849A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist