Provider Demographics
NPI:1487961199
Name:GRIGNON, MARSHALL JOHN (PHARMD)
Entity type:Individual
Prefix:DR
First Name:MARSHALL
Middle Name:JOHN
Last Name:GRIGNON
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 1:3396 HAMMOCKS DR
Mailing Address - Street 2:APARTMENT 208
Mailing Address - City:BALDWINSVILLE
Mailing Address - State:NY
Mailing Address - Zip Code:13027-4252
Mailing Address - Country:US
Mailing Address - Phone:518-368-3686
Mailing Address - Fax:
Practice Address - Street 1:522 W ONONDAGA ST
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:NY
Practice Address - Zip Code:13204-3225
Practice Address - Country:US
Practice Address - Phone:315-475-1366
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-09-02
Last Update Date:2010-09-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY054625183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist