Provider Demographics
NPI:1841455847
Name:GRILL, DAVID S (PHD, RPH)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:S
Last Name:GRILL
Suffix:
Gender:M
Credentials:PHD, RPH
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20 HAZEL AVE
Mailing Address - Street 2:
Mailing Address - City:VOORHEES
Mailing Address - State:NJ
Mailing Address - Zip Code:08043-3402
Mailing Address - Country:US
Mailing Address - Phone:856-783-3955
Mailing Address - Fax:856-783-3955
Practice Address - Street 1:20 HAZEL AVE
Practice Address - Street 2:
Practice Address - City:VOORHEES
Practice Address - State:NJ
Practice Address - Zip Code:08043-3402
Practice Address - Country:US
Practice Address - Phone:856-783-3955
Practice Address - Fax:856-783-3955
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-20
Last Update Date:2008-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ28RI01599500183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist