Healthcare Provider Details

I. General information

NPI: 1962048355
Provider Name (Legal Business Name): JOSHUA GRATTAN PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/21/2019
Last Update Date: 12/22/2019
Certification Date: 12/22/2019
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2907 KRAFFT RD
PORT HURON MI
48060-8628
US

IV. Provider business mailing address

3215 TURNBERRY
PORT HURON MI
48060-2323
US

V. Phone/Fax

Practice location:
  • Phone: 810-987-6346
  • Fax: 810-987-6027
Mailing address:
  • Phone: 734-945-8173
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835P0018X
TaxonomyPharmacist Clinician (PhC)/ Clinical Pharmacy Specialist
License Number5302037350
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: