Healthcare Provider Details

I. General information

NPI: 1740649201
Provider Name (Legal Business Name): ROBERT MATTHEW GRANETT PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/12/2016
Last Update Date: 02/12/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 JEFFERSON AVE SE # SEE
GRAND RAPIDS MI
49503-4502
US

IV. Provider business mailing address

881 SHREWSBURY DR.
CLARKSTON MI
48348-4781
US

V. Phone/Fax

Practice location:
  • Phone: 616-685-5308
  • Fax:
Mailing address:
  • Phone: 248-762-2140
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number5302040754
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: