Individual
DR. DEREK LEE GRIMM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PHARM.D.
Contact information
Practice address
1540 SPRING VALLEY DR, HUNTINGTON, WV 25704-9300
(304) 429-6755
(304) 429-0270
Mailing address
6005 COUNTRY CLUB DR, HUNTINGTON, WV 25705-2038
(651) 238-5732
(304) 568-4425
Taxonomy
Speciality
Code
Description
License number
State
183500000X
Pharmacist
118655
MN
183500000X
Pharmacist
Primary
RP0006863
WV
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
118655
MINN BOARD OF PHARMACY
MN
01
—
RP0006863
WV BOARD OF PHARMACY
WV
Enumeration date
05/30/2007
Last updated
07/10/2007
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