Provider Demographics
NPI:1063057016
Name:GRIMM, JENNA ALEXIS (PHARMD)
Entity type:Individual
Prefix:DR
First Name:JENNA
Middle Name:ALEXIS
Last Name:GRIMM
Suffix:
Gender:F
Credentials:PHARMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 S WASHINGTON ST RM 112
Mailing Address - Street 2:
Mailing Address - City:MT PLEASANT
Mailing Address - State:MI
Mailing Address - Zip Code:48858-4203
Mailing Address - Country:US
Mailing Address - Phone:616-405-2043
Mailing Address - Fax:
Practice Address - Street 1:1341 WRIGHT AVE
Practice Address - Street 2:
Practice Address - City:ALMA
Practice Address - State:MI
Practice Address - Zip Code:48801-1134
Practice Address - Country:US
Practice Address - Phone:989-463-6111
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-11-14
Last Update Date:2019-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI5302411878183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist