Healthcare Provider Details

I. General information

NPI: 1013914829
Provider Name (Legal Business Name): PAT CARROLL-GRANT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

232 MEADOW DR
DOVER DE
19904-1900
US

IV. Provider business mailing address

232 MEADOW DR
DOVER DE
19904-1900
US

V. Phone/Fax

Practice location:
  • Phone: 302-734-1143
  • Fax: 302-653-0506
Mailing address:
  • Phone: 302-734-1143
  • Fax: 302-653-0506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberA1-0001866
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: