Healthcare Provider Details

I. General information

NPI: 1568706745
Provider Name (Legal Business Name): JOSEPH GRANATA PHARM.D.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/12/2012
Last Update Date: 11/12/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9640 MENAUL BLVD NE
ALBUQUERQUE NM
87112-2217
US

IV. Provider business mailing address

9500 OSUNA RD NE APARTMENT 218
ALBUQUERQUE NM
87111-2282
US

V. Phone/Fax

Practice location:
  • Phone: 505-294-4167
  • Fax:
Mailing address:
  • Phone: 586-322-5322
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP00007925
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: