MEDICARE: THOMAS D GRANDSTAFF

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	183500000X	Pharmacist	PS26804	FL
2	183500000X	Pharmacist	26014298A	IN

General Provider Information

NPI Number	:	1811163736
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	THOMAS D GRANDSTAFF

Provider Business Mailing Address
First Line	:	9801 SW 1ST ST
Second Line	:
City	:	PLANTATION
State	:	FL
Zip	:	33324-2311
Country	:	US
Telephone Number	:	954-452-2828
Fax Number	:

Provider Business Practice Location Address
First Line	:	340 SW 24TH ST
Second Line	:
City	:	FT LAUDERDALE
State	:	FL
Zip	:	33315-2547
Country	:	US
Telephone Number	:	954-764-1584
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2008
Last Update Date	:	04/30/2008

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Directions to “ THOMAS D GRANDSTAFF ” Practice Location

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