Provider Demographics
NPI:1447918370
Name:GRAND UNION OF SHERRILL LLC
Entity type:Organization
Organization Name:GRAND UNION OF SHERRILL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER OF PHARMACY
Authorized Official - Prefix:
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNGRIDGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:732-547-9605
Mailing Address - Street 1:7 CORPORATE DR
Mailing Address - Street 2:
Mailing Address - City:KEENE
Mailing Address - State:NH
Mailing Address - Zip Code:03431-5042
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:87 E STATE ST
Practice Address - Street 2:
Practice Address - City:SHERRILL
Practice Address - State:NY
Practice Address - Zip Code:13461-1231
Practice Address - Country:US
Practice Address - Phone:315-361-1689
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes333600000XSuppliersPharmacy