Provider Demographics
NPI:1881751907
Name:GRONWALL, JOSH AARON (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JOSH
Middle Name:AARON
Last Name:GRONWALL
Suffix:
Gender:M
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:SIDNEY
Mailing Address - State:NY
Mailing Address - Zip Code:13838-1017
Mailing Address - Country:US
Mailing Address - Phone:607-563-1841
Mailing Address - Fax:
Practice Address - Street 1:10 MAIN ST
Practice Address - Street 2:
Practice Address - City:SIDNEY
Practice Address - State:NY
Practice Address - Zip Code:13838-1135
Practice Address - Country:US
Practice Address - Phone:607-563-2166
Practice Address - Fax:607-563-8828
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-02
Last Update Date:2022-12-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY047453183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY047453OtherPHARMACY LICENSE