MEDICARE: WALTER GRADY

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	PS33446	FL

General Provider Information

NPI Number	:	1881299758
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	WALTER GRADY

Provider Business Mailing Address
First Line	:	1200 WEST AVE APT 1226
Second Line	:
City	:	MIAMI BEACH
State	:	FL
Zip	:	33139-4323
Country	:	US
Telephone Number	:	305-342-0040
Fax Number	:

Provider Business Practice Location Address
First Line	:	4800 BISCAYNE BLVD
Second Line	:
City	:	MIAMI
State	:	FL
Zip	:	33137-3215
Country	:	US
Telephone Number	:	305-576-4347
Fax Number	:	305-576-1887

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

Provider Enumeration Date	:	12/01/2020
Last Update Date	:	12/01/2020

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Directions to “ WALTER GRADY ” Practice Location

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