Provider Demographics
NPI:1366580979
Name:GRUBB, RICHARD E (RPH)
Entity type:Individual
Prefix:
First Name:RICHARD
Middle Name:E
Last Name:GRUBB
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 1:4343 TODD DR
Mailing Address - Street 2:
Mailing Address - City:SYLVANIA
Mailing Address - State:OH
Mailing Address - Zip Code:43560-3298
Mailing Address - Country:US
Mailing Address - Phone:419-882-1331
Mailing Address - Fax:
Practice Address - Street 1:4122 MONROE ST
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43606-2062
Practice Address - Country:US
Practice Address - Phone:419-473-1531
Practice Address - Fax:419-472-1146
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-03
Last Update Date:2012-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH03-2-13231183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist