Provider Demographics
NPI:1194448597
Name:GRISWOLD, REMINGTON SYLVAN (PHARMD)
Entity type:Individual
Prefix:
First Name:REMINGTON
Middle Name:SYLVAN
Last Name:GRISWOLD
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:PO BOX 141
Mailing Address - Street 2:
Mailing Address - City:MILLTOWN
Mailing Address - State:IN
Mailing Address - Zip Code:47145-0141
Mailing Address - Country:US
Mailing Address - Phone:502-619-4579
Mailing Address - Fax:
Practice Address - Street 1:206 POPLAR ST
Practice Address - Street 2:
Practice Address - City:MILLTOWN
Practice Address - State:IN
Practice Address - Zip Code:47145-2604
Practice Address - Country:US
Practice Address - Phone:502-619-4579
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-21
Last Update Date:2022-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN26029359A183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist