Healthcare Provider Details

I. General information

NPI: 1790899771
Provider Name (Legal Business Name): GRANT PHARMACIST GROUP INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2006
Last Update Date: 01/16/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

40 BROADWAY ST
DRY RIDGE KY
41035-9762
US

IV. Provider business mailing address

40 BROADWAY ST
DRY RIDGE KY
41035-9762
US

V. Phone/Fax

Practice location:
  • Phone: 859-823-0200
  • Fax: 859-823-4500
Mailing address:
  • Phone: 859-823-0200
  • Fax: 859-823-4500

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code3336S0011X
TaxonomySpecialty Pharmacy
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3336M0003X
TaxonomyManaged Care Organization Pharmacy
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3336C0004X
TaxonomyCompounding Pharmacy
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License NumberP07272
License Number StateKY

VIII. Authorized Official

Name: HEATHER FRONK
Title or Position: PARTNER
Credential: PHRMD
Phone: 606-845-3421