Healthcare Provider Details

I. General information

NPI: 1588661201
Provider Name (Legal Business Name): SUSAN L GRANCEY RPH
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 06/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

304 N 3RD ST
CLEARFIELD PA
16830-2527
US

IV. Provider business mailing address

304 N 3RD ST
CLEARFIELD PA
16830-2527
US

V. Phone/Fax

Practice location:
  • Phone: 814-765-5371
  • Fax: 814-762-8755
Mailing address:
  • Phone: 814-765-5371
  • Fax: 814-762-8755

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code183500000X
TaxonomyPharmacist
License NumberRP036635L
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code183500000X
TaxonomyPharmacist
License Number0202 010287
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: