Provider Demographics
NPI:1447540273
Name:GRIZZANTI, JOSEPH G (RPH)
Entity type:Individual
Prefix:
First Name:JOSEPH
Middle Name:G
Last Name:GRIZZANTI
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 1:54 N MAIN ST
Mailing Address - Street 2:RITE AID PHARMACY 2768
Mailing Address - City:CARBONDALE
Mailing Address - State:PA
Mailing Address - Zip Code:18407-1927
Mailing Address - Country:US
Mailing Address - Phone:570-282-3431
Mailing Address - Fax:570-282-5142
Practice Address - Street 1:54 N MAIN ST
Practice Address - Street 2:RITE AID PHARMACY 2768
Practice Address - City:CARBONDALE
Practice Address - State:PA
Practice Address - Zip Code:18407-1927
Practice Address - Country:US
Practice Address - Phone:570-282-3431
Practice Address - Fax:570-282-5142
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-13
Last Update Date:2011-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PARP046312183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist