Healthcare Provider Details

I. General information

NPI: 1811816499
Provider Name (Legal Business Name): KATELYNN GRANGER PHARMD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/15/2026
Last Update Date: 07/15/2026
Certification Date: 07/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL PARK DR STE 110
CONCORD NC
28025-2966
US

IV. Provider business mailing address

225 S POPLAR ST APT 1510
CHARLOTTE NC
28202-0105
US

V. Phone/Fax

Practice location:
  • Phone: 704-403-1370
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1835X0200X
TaxonomyOncology Pharmacist
License Number30538
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: