Healthcare Provider Details

I. General information

NPI: 1962971366
Provider Name (Legal Business Name): GRANE SUPPLY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/15/2018
Last Update Date: 11/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3251 REVERE ST STE 205
AURORA CO
80011-1847
US

IV. Provider business mailing address

105 GAMMA DR STE 100
PITTSBURGH PA
15238-2950
US

V. Phone/Fax

Practice location:
  • Phone: 720-381-3737
  • Fax:
Mailing address:
  • Phone: 412-449-0680
  • Fax: 412-968-5800

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code333600000X
TaxonomyPharmacy
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code3336L0003X
TaxonomyLong Term Care Pharmacy
License Number
License Number State

VIII. Authorized Official

Name: HERBERT H HENNELL
Title or Position: VICE PRESIDENT OF REIMBURSEMENT
Credential:
Phone: 412-963-9150