Healthcare Provider Details

I. General information

NPI: 1588824171
Provider Name (Legal Business Name): GRANDONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/17/2008
Last Update Date: 01/18/2025
Certification Date: 01/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3350 WILKENS AVE SUITE 200
BALTIMORE MD
21229-4600
US

IV. Provider business mailing address

3350 WILKENS AVE SUITE 200
BALTIMORE MD
21229-4600
US

V. Phone/Fax

Practice location:
  • Phone: 410-646-0547
  • Fax: 410-646-0549
Mailing address:
  • Phone: 410-646-0547
  • Fax: 410-646-0549

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3336C0003X
TaxonomyCommunity/Retail Pharmacy
License Number
License Number StateMD

VIII. Authorized Official

Name: MR. CHARLES QUANSAH
Title or Position: PHARMACIST
Credential:
Phone: 410-646-0547