Jeffrey Grundhauser, PHARMD
Individual provider Active NPI Pharmacist · Soda Springs, ID
NPI 1780049577 · NPPES record last updated Dec 21, 2015
Key facts
- NPI
- 1780049577
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Pharmacist 183500000X
- License
- P7312 (ID)
- Practice address
- 89 W 2ND S
Soda Springs, ID 83276-1509 - Phone
- (208) 547-3300
- NPI assigned
- Dec 21, 2015
- Sex
- Male
- Sole proprietor
- Yes
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Doctor of Pharmacy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| P7312 | ID | MD | Pharmacist |
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Pharmacist | 183500000X | P7312 | ID | Yes |
Addresses
Primary practice location
89 W 2ND S
Soda Springs, ID 83276-1509
Mailing address
515 Raven Way Apt D
Chubbuck, ID 83202-1966
Phone (208) 237-9213
Other providers in Soda Springs, ID
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Dec 21, 2015. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.