Healthcare Provider Details

I. General information

NPI: 1932325867
Provider Name (Legal Business Name): HADAR GRANADER RPH.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/18/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8641 N TELEGRAPH RD
DEARBORN HEIGHTS MI
48127-1425
US

IV. Provider business mailing address

1553 ISLAND LN
BLOOMFIELD HILLS MI
48302-1312
US

V. Phone/Fax

Practice location:
  • Phone: 313-274-5332
  • Fax: 313-274-8968
Mailing address:
  • Phone: 248-909-8737
  • Fax: 248-626-7264

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835G0303X
TaxonomyGeriatric Pharmacist
License Number5302019181
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: