Provider Demographics
NPI:1427724681
Name:GRIMM, CAITLIN NICOLE (PHARMD)
Entity type:Individual
Prefix:
First Name:CAITLIN
Middle Name:NICOLE
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 1:25 MURRAY ST APT 7B
Mailing Address - Street 2:
Mailing Address - City:NEW YORK
Mailing Address - State:NY
Mailing Address - Zip Code:10007-2361
Mailing Address - Country:US
Mailing Address - Phone:716-949-3553
Mailing Address - Fax:
Practice Address - Street 1:56 7TH AVE
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10011-6672
Practice Address - Country:US
Practice Address - Phone:212-255-6100
Practice Address - Fax:212-255-6112
Is Sole Proprietor?:Yes
Enumeration Date:2021-08-18
Last Update Date:2021-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NY068620183500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes183500000XPharmacy Service ProvidersPharmacist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program