Healthcare Provider Details

I. General information

NPI: 1730521139
Provider Name (Legal Business Name): STEVE ALAN GRANT JR. PHARM. D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/25/2013
Last Update Date: 12/20/2022
Certification Date: 12/24/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9320 LACKLAND RD
OVERLAND MO
63114-5458
US

IV. Provider business mailing address

9320 LACKLAND RD
SAINT LOUIS MO
63114-5458
US

V. Phone/Fax

Practice location:
  • Phone: 314-429-4636
  • Fax: 314-429-8664
Mailing address:
  • Phone: 314-429-4636
  • Fax: 314-429-8664

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number17500
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number2019046068
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: