Provider Demographics
NPI:1912435660
Name:GRIBBIN, JOHN PHILIP SR (RPH)
Entity Type:Individual
Prefix:MR
First Name:JOHN
Middle Name:PHILIP
Last Name:GRIBBIN
Suffix:SR
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 1:100 MAIN ST N
Mailing Address - Street 2:
Mailing Address - City:SOUTHBURY
Mailing Address - State:CT
Mailing Address - Zip Code:06488-3840
Mailing Address - Country:US
Mailing Address - Phone:203-262-4559
Mailing Address - Fax:844-411-6435
Practice Address - Street 1:100 MAIN ST N
Practice Address - Street 2:
Practice Address - City:SOUTHBURY
Practice Address - State:CT
Practice Address - Zip Code:06488-3840
Practice Address - Country:US
Practice Address - Phone:203-262-4559
Practice Address - Fax:844-411-6435
Is Sole Proprietor?:No
Enumeration Date:2017-05-25
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7440183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist