Healthcare Provider Details

I. General information

NPI: 1811599061
Provider Name (Legal Business Name): CAROL ELIZABETH GRANT RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/12/2020
Last Update Date: 11/12/2020
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5146 MARION MT GILEAD ROAD
MARION OH
43302
US

IV. Provider business mailing address

5146 MARION MT GILEAD RD
MARION OH
43302
US

V. Phone/Fax

Practice location:
  • Phone: 740-389-4573
  • Fax: 740-389-4579
Mailing address:
  • Phone: 740-389-4573
  • Fax: 740-389-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License Number03221340
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: