Healthcare Provider Details

I. General information

NPI: 1952235384
Provider Name (Legal Business Name): GRANT ANDERSON BROWNELL
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/10/2026
Last Update Date: 06/10/2026
Certification Date: 06/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11062 BOLZANO WAY
TRUCKEE CA
96161-6560
US

IV. Provider business mailing address

11062 BOLZANO WAY
TRUCKEE CA
96161-6560
US

V. Phone/Fax

Practice location:
  • Phone: 408-438-3525
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183700000X
TaxonomyPharmacy Technician
License Number197278
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: