Provider Demographics
NPI:1841284452
Name:GRIFFIN, JOHN J (RPH)
Entity type:Individual
Prefix:MR
First Name:JOHN
Middle Name:J
Last Name:GRIFFIN
Suffix:
Gender:M
Credentials:RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:777 LESLIE LN
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:60423-1033
Mailing Address - Country:US
Mailing Address - Phone:815-469-2820
Mailing Address - Fax:219-836-5657
Practice Address - Street 1:777 LESLIE LN
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:IL
Practice Address - Zip Code:60423-1033
Practice Address - Country:US
Practice Address - Phone:815-469-2820
Practice Address - Fax:219-836-5657
Is Sole Proprietor?:No
Enumeration Date:2005-09-09
Last Update Date:2011-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL051029079183500000X
IN26015904A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
IL051028079OtherBOARD OF PHARMACY
IN26015904AOtherBOARD OF PHARMACY